Publications by authors named "Saurabh Kumar Gupta"

107 Publications

Bilateral tracheal bronchi in a patient with right isomerism.

J Cardiovasc Comput Tomogr 2021 Nov 24. Epub 2021 Nov 24.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcct.2021.11.010DOI Listing
November 2021

Intrapulmonary invagination of right subclavian artery with a dual left anterior descending artery in a child with tetralogy of Fallot.

J Card Surg 2021 Oct 15. Epub 2021 Oct 15.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

We report a case of a 10-month-old cyanotic child with tetralogy of Fallot showing intrapulmonary invagination of right subclavian artery and presence of dual left anterior descending artery with the high take-off of the right coronary artery. This case highlights the role of computed tomography angiography in depicting vascular anatomy (arch vessels and coronary arteries) in patients with congenital heart diseases and in the planning of surgical management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.16069DOI Listing
October 2021

Effect of change in tidal volume on left to right shunt across ventricular septal defect in children - A pilot study.

Ann Pediatr Cardiol 2021 Jul-Sep;14(3):350-355. Epub 2021 Aug 20.

Department of Cardiac Anaesthesia, CNC, All India Institute of Medical Sciences, New Delhi, India.

Background: Pulmonary vascular resistance, an important determinant of shunting across ventricular septal defects (VSD), rises at both extremes of lung volume.

Aims: We sought to determine the effect of changes in tidal volumes (VT) on pulmonary blood flow (Qp), systemic blood flow (Qs), and shunt (Qp/Qs) in children with VSD.

Setting: Single-center teaching hospital.

Design: Prospective observational study.

Methods: Thirty children with a mean age of 11.8 ± 5 months undergoing surgical closure of VSD were studied. Hemodynamics and shunt-related parameters were assessed using transthoracic echocardiography measured at three different VT i.e. 10, 8, and 6-ml/kg keeping the minute ventilation constant.

Results: Reduction in VT from 10 to 8 to 6 ml/kg led to a reduction in gradient across VSD measuring 23.5, 20 and 13 mmHg respectively ( < 0.001). Similarly, right ventricluar outflow tract (RVOT) diameter, RVOT velocity time integral, Qp (57.3 ± 18.1, 50.6 ± 16.9, 39.9 ± 14.7 mL; < 0.001), Qs (24.1 ± 10.4, 20.0 ± 8.7, 15.3 ± 6.9 mL; < 0.001) and peak airway pressure (17.2 ± 1.5, 15.8 ± 1.3, 14.5 ± 1.2 cmHg; < 0.001) showed progressive decline with decreasing VT from 10 to 8 to 6 ml/kg, respectively. However, Qp/Qs (2.4 ± 0.4, 2.6 ± 0.4, 2.6 ± 0.4) demonstrated a minor increasing trend.

Conclusion: Lower V reduces the gradient across VSD, the pulmonary blood flow, and the peak airway pressure. Hence, ventilation with lower V and higher respiratory rate maintaining adequate minute ventilation might be preferable in children with VSD. Further studies are required to confirm the findings of this pilot study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/apc.apc_1_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457296PMC
August 2021

Outcome of COVID-19-positive children with heart disease and grown-ups with congenital heart disease: A multicentric study from India.

Ann Pediatr Cardiol 2021 Jul-Sep;14(3):269-277. Epub 2021 Aug 26.

Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India.

Background: Outcome data of children with heart disease who acquired COVID-19 infection are limited.

Aims: We sought to analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with congenital heart disease (GUCH) who had a laboratory-confirmed COVID-19 infection.

Settings And Design: This is a retrospective, multicentric, observational study.

Materials And Methods: The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group.

Results: From 24 pediatric cardiac centers across India, we included 94 patients with a median age of 12.5 (interquartile range 3-96) months and 49 (52.1%) patients were males. Majority (83 patients, 88.3%) were children. One-third of the patients ( = 31, 33.0%) had acyanotic congenital heart disease, and 41.5% ( = 39) were cyanotic, with > 80% of the patients being unoperated. Only 30 (31.9%) patients were symptomatic for COVID-19 infection, while the rest were incidentally detected positive on screening. A total of 13 patients died (case fatality rate: 13.8%). The in-hospital mortality rate among hospitalized patients was significantly higher among COVID-19-positive cases (13 of 48; 27.1%) as compared to COVID-negative admissions (9.2%) during the study period ( < 0.001). On multivariate analysis, the independent predictors of mortality among COVID-19-positive cases were severity of illness at admission (odds ratio [OR]: 535.7, 95% confidence interval [CI]: 6.9-41,605, = 0.005) and lower socioeconomic class (OR: 29.5, 95% CI: 1.1-814.7, = 0.046).

Conclusions: Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/apc.apc_134_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457291PMC
August 2021

Impact of COVID-19 pandemic on pediatric cardiac services in India.

Ann Pediatr Cardiol 2021 Jul-Sep;14(3):260-268. Epub 2021 Aug 26.

Department of Pediatrics, Division of Pediatric Cardiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India.

Background: COVID-19 pandemic has disrupted pediatric cardiac services across the globe. Limited data are available on the impact of COVID.19 on pediatric cardiac care in India.

Aims: The aims are to study the impact of COVID-19 pandemic on the care of children with heart disease in India in terms of number of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries.

Settings And Design: This is a retrospective, multicentric, observational study.

Methods: We collected monthly data on the number and characteristics of outpatient visits, hospitalizations, catheter-based interventions, and cardiac surgeries and major hospital statistics, over a period of 5 months (April to August 2020), which coincided with the first wave of COVID-19 pandemic in India and compared it with data from the corresponding months in 2019.

Results: The outpatient visits across the 24 participating pediatric cardiac centers decreased by 74.5% in 2020 ( = 13,878) as compared to the corresponding period in 2019 ( = 54,213). The reduction in the number of hospitalizations, cardiac surgeries, and catheterization procedures was 66.8%, 73.0%, and 74.3%, respectively. The reduction in hospitalization was relatively less pronounced among neonates as compared to infants/children (47.6% vs. 70.1% reduction) and for emergency surgeries as compared to elective indications (27.8% vs. 79.2%). The overall in-hospital mortality was higher in 2020 (8.1%) as compared to 2019 (4.8%), with a higher postoperative mortality (9.1% vs. 4.3%).

Conclusions: The current COVID-19 pandemic significantly impacted the delivery of pediatric cardiac care across India with two-third reduction in hospitalizations and cardiac surgeries. In an already resource-constrained environment, the impact of such a massive reduction in the number of surgeries could be significant over the coming years. These findings may prove useful in formulating strategy to manage subsequent waves of ongoing COVID-19 pandemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/apc.apc_133_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457266PMC
August 2021

Outcomes of multisystem inflammatory syndrome in children temporally related to COVID-19: a longitudinal study.

Rheumatol Int 2021 Oct 19. Epub 2021 Oct 19.

All India Institute of Medical Sciences, New Delhi, India.

To study the clinical, laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to coronavirus disease 2019 (COVID-19) in a resource-limited setting. All children meeting the World Health Organization case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the stata-12 software. Thirty-one children with MIS-C were enrolled in an 11-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding; gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight percent of children presented with shock, and 22.5% required mechanical ventilation. HSP like rash, gangrene and arthritis were uncommon clinical observations.The median duration of hospital stay was 9 (6.5-18.5) days: four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in non-survivors as compared to survivors [1061 (581, 2750) vs 309.5 (140, 720.08), p value = 0.045]. Six patients had coronary artery involvement; five recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome. Most children with MIS-C present with acute hemodynamic and respiratory symptoms.The outcome is favorable in children without preexisting comorbidities.Raised ferritin level may be a poor prognostic marker. The coronary outcomes at follow-up were reassuring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00296-021-05030-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8524205PMC
October 2021

Non-specific aortoarteritis (NSAA) in children: a prospective observational study.

BMJ Paediatr Open 2021 9;5(1):e001106. Epub 2021 Aug 9.

Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Objective: Prospective data on clinical profile, natural history and outcomes of NSAA (non-specific aortoarteritis) in children is limited. We initiated this prospective study to evaluate the short-term and medium-term outcomes of NSAA in children.

Design: Prospective observational study.

Setting: Tertiary care hospital in India.

Patients: We included 28 consecutive children (<15 years) with a diagnosis of NSAA.

Main Outcome Measures: Clinical profile, symptoms, left ventricular ejection fraction (LVEF), the pattern of vessel involvement, complications and markers of disease activity were assessed at the time of diagnosis. All the patients underwent treatment and interventions as per the current guidelines and were followed up for a mean duration of 13.5±6.7 months for disease activity and outcomes.

Results: The mean age of the cohort was 10±2.9 years (14 boys). Twenty (71%) patients had hypertension. Half of the children presented with acute decompensated heart failure (ADHF). Only 21 patients (75%) met Sharma modified Ishikawa criteria for the diagnosis. The children with active disease (36%) were managed with immunosuppressive drugs. Percutaneous and surgical interventions were performed in 26 (93%) children. New York Heart Association functional class, LVEF and control of hypertension improved in most children on follow-up. Four children developed vascular restenosis requiring reinterventions. There was no death during mid-term follow-up.

Conclusions: Children with NSAA, unlike adults seldom present with classical features of the disease. ADHF and ventricular dysfunction are strikingly common in children. Appropriate immunosuppressive therapy for active disease and timely intervention improves clinical outcomes over a medium term follow-up. Future studies assessing long-term outcome are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjpo-2021-001106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354261PMC
August 2021

Clarifying the anatomy of the superior sinus venosus defect.

Heart 2021 Aug 20. Epub 2021 Aug 20.

Biosciences Institute, University of Newcastle, Newcastle-upon Tyne, UK.

Objectives: We sought to clarify the variations in the anatomy of the superior cavoatrial junction and anomalously connected pulmonary veins in patients with superior sinus venosus defects using computed tomographic (CT) angiography.

Methods: CT angiograms of 96 consecutive patients known to have superior sinus venosus defects were analysed.

Results: The median age of the patients was 34.5 years. In seven (7%) patients, the defect showed significant caudal extension, having a supero-inferior dimension greater than 25 mm. All patients had anomalous connection of the right superior pulmonary vein. The right middle and right inferior pulmonary vein were also connected anomalously in 88 (92%) and 17 (18%) patients, respectively. Anomalous connection of the right inferior pulmonary vein was more common in those with significant caudal extension of the defect (57% vs 15%, p=0.005). Among anomalously connected pulmonary veins, the right superior, middle, and inferior pulmonary veins were committed to the left atrium in 6, 17, and 11 patients, respectively. The superior caval vein over-rode the interatrial septum in 67 (70%) patients, with greater than 50% over-ride in 3 patients.

Conclusion: Anomalous connection of the right-sided pulmonary veins is universal, but is not limited to the right upper lobe. Not all individuals have over-riding of superior caval vein. In a minority of patients, the defect has significant caudal extension, and anomalously connected pulmonary veins are committed to the left atrium. These findings have significant clinical and therapeutic implications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/heartjnl-2021-319334DOI Listing
August 2021

Development and evaluation of self-care intervention to improve self-care practices among people living with type 2 diabetes mellitus: a mixed-methods study protocol.

BMJ Open 2021 07 1;11(7):e046825. Epub 2021 Jul 1.

Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, Chandigarh, India.

Introduction: The management of diabetes mellitus (DM) depends on medication adherence, self-care and regular follow-up to prevent complications and premature mortality. This study aims to develop and implement the behavioural change theory and model based diabetes self-care intervention package to improve self-care practices among people living with type 2 DM.

Methods And Analysis: An exploratory sequential mixed-method study design wherein, quantitative follows qualitative will be used to develop, implement and evaluate the effect of diabetes self-care intervention package among people living with type 2 diabetes. The qualitative research method will be used to identify barriers and facilitators for self-care practices among people living with type 2 DM and will also provide the basis for the development of the diabetes self-care intervention package. The quasi-experimental with control study design will be used to evaluate the developed intervention package among 220 randomly selected people living with type 2 diabetes in both intervention and control arms. Baseline, follow-ups and endline data will be collected using same prevalidated and structured questionnaire for each self-care activity. Difference-in-difference analysis will be used to measure for changes in the proportion of people living with type 2 DM doing different component of self-care practices, preintervention and postintervention in both arms.

Ethics And Dissemination: Permission for conducting the study has been taken from Institutional Ethical Committee of PGIMER, Chandigarh (Ref no. NK/4538/PhD/226, Dated 18.08.18). The findings of the trial will be disseminated through publication in peer-reviewed journals.

Trial Registration Number: CTRI/2018/10/016108; Pre-results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-046825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252870PMC
July 2021

All that attaches to atrial septum is not myxoma: deception is everywhere!

Cardiol Young 2021 Oct 28;31(10):1680-1681. Epub 2021 Jun 28.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Preterm neonates - especially those with prolonged duration of intensive care stay - are prone to develop fungal endocarditis. Majority of these children have a stormy course, however, a few may be relatively asymptomatic. Occasionally these vegetations may be large and pedunculated, originating from the atrial septum, mimicking a cardiac myxoma on echocardiography.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S104795112100250XDOI Listing
October 2021

Delivery sheath tip invagination - An unusual cause of failure to retrieve duct occluder.

Ann Pediatr Cardiol 2021 Apr-Jun;14(2):242-243. Epub 2021 Apr 10.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Transcatheter closure of patent ductus arteriosus is the standard of care. Retrieval of a duct occluder device is generally easy until it is detached from the delivery cable. We report two instances of failed retrieval of the device due to sheath tip invagination. The report highlights the importance of prompt identification of the mechanism of unforeseen complications in managing them effectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/apc.APC_165_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174637PMC
April 2021

Enhanced biomechanical performance of additively manufactured Ti-6Al-4V bone plates.

J Mech Behav Biomed Mater 2021 07 23;119:104552. Epub 2021 Apr 23.

Department of Materials Engineering, Indian Institute of Science, Bangalore, India. Electronic address:

As the global trauma fixation devices market expands rapidly, it is imperative to improve the production of fixation devices through enhanced design accuracy and fit for best performance and maximum patient comfort. Selective laser melting (SLM) is one of the mature additive manufacturing methods, which provides a viable route for the rapid production of such devices. In this work, the ability of SLM to produce near-net-shape parts, as desired for medical implants, was utilized for the fabrication of bone plates from Ti-6Al-4V alloy powder. Martensitic microstructure obtained after the printing of alloy resulted in poor ductility, limiting its application in the field of orthopedics. A specially designed repeated cyclic heating and cooling close to but below the β-transus was used to transform from acicular to a bimodal microstructure without the need for plastic deformation prior to heat treatment for improving the ductility. Bone plates subjected to this heat treatment were mechanically tested by means of tensile and 3-point bend tests and demonstrated large improvement in ductility, and the values were comparable to those similar plates prepared from wrought alloy. Other important properties required for implants were assessed, such as corrosion resistance in simulated body fluid and cytocompatibility in vitro using MC3T3-E1 cells. These results for the bone plate after heat treatment were excellent and similar to those of the additively manufactured and wrought plates. Taken together, the performance of the additively manufactured bone plates after subjecting to heat treatment was similar to those of bone plate manufactured using wrought alloy. These results have important implications for the fabrication of patient-specific metallic orthopedic devices using SLM without compromising their biomechanical performance by subjecting them to a tailored heat treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmbbm.2021.104552DOI Listing
July 2021

Anaglyph stereo virtual dissection: a novel inexpensive method for stereoscopic visualisation of intracardiac anatomy on CT angiogram.

Cardiol Young 2021 Apr 14:1-4. Epub 2021 Apr 14.

Department of Vitreo-Retina Services, Shroff Eye Centre, New Delhi, India.

Three-dimensional visualisation is invaluable for evaluating cardiac anatomy. Patient-specific three-dimensional printed models of the heart are useful but require significant infrastructure. The three-dimensional virtual models, derived from 3D echocardiography, computed tomographic (CT) angiography or cardiac magnetic resonance (CMR), permit excellent visualisation of intracardiac anatomy, but viewing on a two-dimensional screen obscures the third dimension. Various forms of extended reality, such as virtual reality and augmented reality, augment the third dimension but only using expensive equipment. Herein, we report a simple technique of anaglyph stereoscopic visualisation of three-dimensional virtual cardiac models. The feasibility of achieving stereovision on a personal computer, using open-source software, and the need for inexpensive anaglyph glasses for viewing make it extremely cost-effective. Further, the retained depth perception of resulting stereo images in electronic and printed format makes sharing with other members of the team easy and effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1047951121001323DOI Listing
April 2021

Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia: A Randomized, Open-Label, Noninferiority Study.

JACC Clin Electrophysiol 2021 08 31;7(8):1052-1060. Epub 2021 Mar 31.

Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.

Objectives: This study sought to compare the efficacy of ivabradine and amiodarone in the management of postoperative junctional ectopic tachycardia (JET) after cardiac surgery in children.

Background: JET is a serious arrhythmia occurring in children after cardiac surgery and requires aggressive management. Amiodarone has been conventionally used in its treatment. Recent studies have reported the utility of ivabradine in this regard.

Methods: In this open-label randomized controlled trial, 94 children (age ≤18 years) who developed postoperative JET were allocated to receive either amiodarone or ivabradine. The primary endpoint was restoration of normal sinus rhythm.

Results: Sinus rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean difference of treatment effect: 2.3%; 95% confidence interval: -6.7% to 11.5%). The median (interquartile range) time taken to achieve sinus rhythm conversion was similar in both the groups: 21.5 (17-30.2) hours versus 22 (13.4-38.5) hours (p = 0.36)]. The time taken to rate control of JET was significantly less in the amiodarone group: median 7.0 (5.5-9.5) hours versus 8.0 (5.8-10.8) hours (p = 0.02)]. No drug-related adverse events were observed in the ivabradine group.

Conclusions: Oral ivabradine is not inferior to intravenous amiodarone in converting postoperative JET to sinus rhythm. There was no difference in time taken to sinus rhythm conversion between the groups, although the rate control was earlier in patients who received amiodarone. Monotherapy with ivabradine may be considered as an alternative to amiodarone in the management of postoperative JET. (Comparison of Two Drugs, Ivabradine and Amiodarone, in the Management of Junctional Ectopic Tachycardia, an Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo Cardiac Surgery: CTRI/2018/08/015182).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacep.2021.01.020DOI Listing
August 2021

An evidence-based scoring system to diagnose acute rheumatic fever with carditis in children.

Int J Cardiol 2021 06 2;333:146-151. Epub 2021 Mar 2.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Backgound: Acute rheumatic fever (ARF) with carditis and chronic rheumatic heart disease (RHD) may be difficult to differentiate and may lead to missed diagnosis of carditis. We aimed to determine differences between these groups and to develop a new scoring system for this purpose.

Methods: Children (N = 514; mean age 11.6 ± 2.8, range 5-18 years; 65% males) enrolled in a RHD registry at a tertiary care centre were studied. Clinical, laboratory and echocardiographic features of acute rheumatic carditis group (N = 126) were compared with chronic RHD group (N = 388). We performed multiple regression analysis and then developed a new scoring system using independent predictors. Accuracy of this scoring system was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Patients with ARF and carditis were younger, more commonly had history of fever, arthritis/arthralgias and had worse NYHA class. On echocardiography, severity of mitral regurgitation, presence of mitral leaflet nodules, mitral valve prolapse and pericardial effusion were more common in ARF group. On multiple regression analysis, following features were found to be independently predictive of ARF with carditis: age -negative association, NYHA class, severity of mitral regurgitation, mitral leaflet nodules, erythrocyte sedimentation rate and antistreptolysin titer. Based on these 6 variables, a new scoring system (0-13) was developed. A score of 5 or more was found to be best threshold for diagnosis of carditis (ROC AUC 0.87, sensitivity 76%, specificity 79%).

Conclusion: A new scoring system based on independent statistical associations appears promising for differentiating ARF with carditis from chronic RHD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2021.02.084DOI Listing
June 2021

Clinical and Laboratory Parameters Associated with Septic Myocardial Dysfunction in Children with Septic Shock.

Indian J Pediatr 2021 08 18;88(8):809-812. Epub 2021 Feb 18.

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.

The authors' objective was to determine the association of clinical and laboratory parameters at admission with septic myocardial dysfunction (SMD) in children with septic shock. A chart review of children aged 3 mo-17 y with fluid refractory septic shock who underwent echocardiography within 3 h of admission was undertaken (2015-2017). Univariate followed by multivariate analysis was performed to identify factors associated with SMD. Of the 95 children fulfilling the inclusion criteria, SMD was diagnosed in 44 (46%) children. Children 'with SMD' had longer capillary refill time (CRT), increased lactate, lower platelet count, increased blood urea, and increased alanine aminotransferase (ALT) (p < 0.05 for all) compared to those 'without SMD'. On multivariate analysis, none of these were significant. The mortality rate was higher in those 'with SMD' than 'without SMD' [36% vs. 20% (p = 0.07)]. Prolonged CRT, increased lactate, lower platelet count, increased blood urea and elevated liver enzymes at admission may be associated with SMD in children with septic shock and may warrant early assessment of cardiac function.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12098-021-03688-7DOI Listing
August 2021

Role of self-care in COVID-19 pandemic for people living with comorbidities of diabetes and hypertension.

J Family Med Prim Care 2020 Nov 30;9(11):5495-5501. Epub 2020 Nov 30.

Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

People living with comorbidities especially chronic non-communicable disease (NCDs) like diabetes and hypertension are at greater risk of acquiring severe form of Corona Virus Disease (COVID-19) infection known to be caused by Severe Acute Respiratory Syndrome-CoV -2 (SARS-CoV-2) due to underlying immunodeficiency. The government has taken various public health measures to reduce the risk of infection, such as physical distancing, Information Education and Communication (IEC) messages regarding hand-washing, usage of masks, and avoidance of unnecessary travel including lockdown to combat the spread of disease. However, nationwide lockdown due to COVID-19 pandemic has also confronted the existing health care system (clinician centric approach) for the management of diabetes and hypertension in India. Using secondary source of data from specific website and search engine a review was done for existing guidelines and literature focusing on the various components of self-care management (patient-centered care) and highlights the importance of self-care management education to cope up with twin pandemic of COVID-19 and NCDs. An attempt was also made to highlight the use of eHealth to manage diabetes and hypertension which may act as a bridge to fill the gap between primary care physician and patient's amid lockdown and help physician to deliver comprehensive care for people suffering from comorbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/jfmpc.jfmpc_1684_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842493PMC
November 2020

Atrial flutter: yet another cause of arterial desaturation in atrial septal defect.

Cardiol Young 2021 Jun 26;31(6):1027-1029. Epub 2021 Jan 26.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi110029, India.

Pulmonary hypertension is not the only cause of arterial desaturation in patients with atrial septal defect. Arterial desaturation can also occur with normal pulmonary artery pressure making it mandatory to understand the mechanism to avoid erroneous diagnosis. In this report, for the first time, we demonstrate atrial flutter as the cause of arterial desaturation in a patient with large atrial septal defect despite normal pulmonary artery pressure, which was normalised following successful radiofrequency ablation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S104795112100010XDOI Listing
June 2021

Cobra head deformity of atrial septal occluder: blessing in disguise.

Cardiol Young 2021 Mar 18;31(3):488-489. Epub 2020 Nov 18.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

It is not uncommon to have prolapse of the atrial septal occluder device despite accurate measurement of atrial septal defect and an appropriately chosen device. This is particularly a problem in cases with large atrial septal defect with absent aortic rim. Various techniques have been described for successful implantation of atrial septal occluder in such a scenario. The essence of all these techniques is to prevent prolapse of the left atrial disc through the defect while the right atrial disc is being deployed. In this brief report, we illustrate the use of cobra head deformity of the device to successfully deploy the device across the atrial septum.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1047951120004084DOI Listing
March 2021

How best to describe the pharyngeal arch arteries when the fifth arch does not exist?

Cardiol Young 2020 Nov 4;30(11):1708-1710. Epub 2020 Nov 4.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

In the accompanying article appearing in this issue of the Journal, Prabhu and his colleagues, from Bengalaru in India, describe their experience with patients having a right aortic arch. They discuss the fact that the anomalous arrangements they encountered can all be interpreted on the basis of the hypothetical double arch proposed by Edwards. They point to the fact that interpretation of the developmental changes underscoring the production of the double arch is currently confused by reference to the so-called Rathke diagram, in which six sets of arteries are shown extending through the mesenchyme of the pharyngeal arches. As the authors point out, Graham and his associates have now shown that the alleged fifth set of pharyngeal arches do not exist. Based on our own observations, we endorse this statement. It means that new explanations must now be provided for the lesions previously described on the basis of persistence of the alleged artery of the fifth pharyngeal arch. We have previously claimed to have observed such an artery in a human fetus. We now believe, on the basis of our latest findings, that our earlier observation is better explained on the basis of presence of a collateral channel. We suggest that the so-called "fifth arch arteries" are themselves then best explained either on the basis of existence of such collateral channels, or remodelling of the aortic sac, which is the manifold, during development, that gives rise to the pharyngeal arch arteries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1047951120003807DOI Listing
November 2020

Selective Fluorometric Analysis of Hg(II) in Industrial Waste Water Samples.

J Fluoresc 2020 Dec 30;30(6):1375-1381. Epub 2020 Sep 30.

Department of Chemistry, National Institute of Technology, Raipur, CG, India.

The highly selective and sensitive fluorometric method has been developed for trace level determination of Hg(II) is based on photo-induced electron transfer between rhodamine-6G dye and metal complex. Quenching in fluorescence intensity by fluorescence resonance energy transfer (FRET) is due to interaction between metal ion complex and dye. The fluorescence emitted was measured at 510 and 550 nm, for excitation and emission wavelengths respectively. Possible interferences present in water samples, which could affect the analytical response are studied and determined. The calibration graph was dynamically linear from 0.002 to 0.05 mgL of Hg(II) with limit of detection 7 × 10 mgL and limit of quantitation 1.9 × 10 mgL. The Stern-Volmer constant (K) calculated for the quenching of R-6G with Hg (II) was 8.47 Lmg s at optimized reaction conditions. The proposed FRET based fluorometric method was applied successfully in different industrial wastewater samples with satisfactory outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10895-020-02627-7DOI Listing
December 2020

Isolated systemic arterial supply to normal lung - an unusual cause of extracardiac left-to-right shunt.

Cardiol Young 2020 Dec 18;30(12):1946-1950. Epub 2020 Sep 18.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

Isolated systemic arterial supply to a normal lung, a type of bronchopulmonary vascular malformation, is a rare cause of extracardiac left-to-right shunt. We describe such a case that was successfully managed by transcatheter closure of the anomalous arterial supply to otherwise normal lung.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1047951120002851DOI Listing
December 2020

Systolic excursion of the leaflets of the truncal valve: An unusual mechanism for pulmonary stenosis in common arterial trunk.

Ann Pediatr Cardiol 2020 Jul-Sep;13(3):194-198. Epub 2020 Jun 29.

Institute of Genetic Medicine, University of Newcastle, Newcastle upon Tyne, UK.

Background: Pulmonary stenosis in patients with common arterial trunk protects the pulmonary vasculature. In our recently published prospective study of common arterial trunk, some patients with sinusal origin of the pulmonary arterial segment had pulmonary stenosis induced by systolic excursion of a truncal valvar leaflet. We aimed to determine the detailed morphologic characteristics of this unusual finding.

Methods And Results: All 70 patients underwent echocardiography and computed tomographic angiography as per predefined study protocol. In selected cases, we also performed cardiac catheterization. Among 27 patients with aortic dominance, we found sinusal origin of the pulmonary arterial segment. In 5 of these patients, pulmonary stenosis was induced by systolic excursion of a truncal valvar leaflet. In all these patients, the truncal valve was trisinusate, albeit with asymmetric sinuses. The pulmonary arterial segment arose from the largest left sinus with its relatively large leaflet obstructing the pulmonary orifice during systole. In the remaining 22 patients, without pulmonary stenosis but with sinusal origin of pulmonary arterial segment, the truncal valve was quadrisinusate in 7, bisinusate in 2, and trisinusate in 13. None of the patients with quadrisinusate and bisinusate truncal valves had pulmonary stenosis. Among the 13 patients with trisinusate valves, the sinuses of the truncal valve were symmetrical in 6, while in 7, the pulmonary orifice originated from a smaller asymmetric sinus.

Conclusion: Pulmonary stenosis, produced by a relatively large leaflet of an asymmetric truncal sinus, may prevent early development of pulmonary vascular disease. Timely recognition of this unusual mechanism of pulmonary stenosis is important for optimal management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/apc.APC_22_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437627PMC
June 2020

Virtual Dissection: Emerging as the Gold Standard of Analyzing Living Heart Anatomy.

J Cardiovasc Dev Dis 2020 Aug 12;7(3). Epub 2020 Aug 12.

UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.

Traditionally, gross cardiac anatomy has been described mainly based on the findings in the dissection suite. Analyses of heart specimens have contributed immensely towards building a fundamental knowledge of cardiac anatomy. However, there are limitations in analyzing the autopsied heart removed from the thorax. Three-dimensional imaging allows visualization of the blood-filled heart in vivo in attitudinally appropriate fashion. This is of paramount importance for not only demonstration of cardiac anatomy for educational purposes, but also for the detailed anatomical evaluation in patients with acquired and congenital heart disease. In this review, we discuss the advantages of three-dimensional imaging, specifically focusing on virtual dissection, a volume rendering-based reconstruction technique using computed tomographic data. We highlight examples of three-dimensional imaging in both education and guiding patient management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcdd7030030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7570024PMC
August 2020

Printing of Three-Dimensional Heart Models-Is It Worth the Expense?

CJC Open 2020 Jul 31;2(4):192-194. Epub 2020 Mar 31.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cjco.2020.03.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365816PMC
July 2020

Every face tells a story-unravelling a case of bidirectional ventricular tachycardia.

Indian Pacing Electrophysiol J 2020 Sep - Oct;20(5):199-202. Epub 2020 Jun 29.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Bidirectional ventricular tachycardia is a rare form of tachycardia. We hereby report a case of bidirectional ventricular tachycardia in an 8-year-old boy wherein careful clinical exami-nation led to the diagnosis of Andersen Tawil syndrome. The case also demonstrates the efficacy of flecainide in managing bidirectional ventricular tachycardia in the setting of Andersen Tawil syndrome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ipej.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517587PMC
June 2020

Imaging Modalities in Congenital Heart Disease.

Indian J Pediatr 2020 05 13;87(5):385-397. Epub 2020 Apr 13.

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.

Cardiac imaging provides invaluable guidance at all stages of the management of congenital heart disease. Advances in the field of cardiac imaging have contributed immensely to improved outcomes of these patients. Echocardiography remains the first-line imaging modality. Non-invasive cross-sectional imaging using computed tomography and magnetic resonance imaging supplements morphologic and physiologic evaluation and are being increasingly used for diagnosis and follow-up of patients with a malformed heart. Cardiac catheterization, being invasive, is mostly reserved for accurate assessment of hemodynamic status and percutaneous interventions. Simultaneous improvement in visualization techniques has amplified the information obtained from various imaging modalities. This review provides an overview of cardiac imaging and visualization techniques commonly used in the diagnosis and management of patients with congenital heart disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12098-020-03209-yDOI Listing
May 2020

Fifth arch arteries: Why do developmental biologists encounter them so infrequently?

Pediatr Int 2020 Mar;62(3):421

Institute of Genetic Medicine, University of Newcastle, Newcastle upon Tyne, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ped.14129DOI Listing
March 2020

Virtual dissection: An alternative to surface-rendered virtual three-dimensional cardiac model.

Ann Pediatr Cardiol 2020 Jan-Mar;13(1):102-103. Epub 2019 Dec 4.

Institute of Genetic Medicine, University of Newcastle, Newcastle-upon-Tyne, UK.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/apc.APC_127_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979021PMC
December 2019

Delayed cord clamping in Rh-alloimmunised infants: a randomised controlled trial.

Eur J Pediatr 2020 Jun 23;179(6):881-889. Epub 2020 Jan 23.

Department of Pediatrics, Division of Neonatology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Despite advancement in medical care, Rh alloimmunisation remains a major cause of neonatal hyperbilirubinaemia, neuro-morbidity, and late-onset anaemia. Delayed cord clamping (DCC), a standard care now-a-days, is yet not performed in Rh-alloimmunised infants due to paucity of evidence. Hence, we randomised these infants of 28- to 41-week gestation to delayed cord clamping (N = 36) or early cord clamping (N = 34) groups. The primary outcome variable was venous packed cell volume (PCV) at 2 h of birth. The secondary outcomes were incidence of double volume exchange transfusion (DVET) and partial exchange transfusion (PET), duration of phototherapy (PT), functional echocardiography (parameters measured: superior vena cava flow, M-mode fractional shortening, left ventricular output, myocardial perfusion index, and inferior vena cava collapsibility) during hospital stay, and blood transfusion (BT) until 14 weeks of life. Neonates were managed as per unit protocol. The baseline characteristics of enrolled infants were comparable between the groups. The median (IQR) gestation and mean (SD) birth weight of enrolled infants were 35 (33-37) weeks and 2440 (542) g, respectively. The DCC group had a higher mean PCV at 2 h of life (48.4 ± 9.2 vs. 43.5 ± 8.7, mean difference 4.9% (95% CI 0.6-9.1), p = 0.03). However, incidence of DVET and PET, duration of PT, echocardiography parameters, and BT until 14 weeks of postnatal age were similar between the groups.Conclusion: DCC in Rh-alloimmunised infants improved PCV at 2 h of age without significant adverse effects.Trial registration: Clinical Trial Registry of India (CTRI), Ref/2016/11/012572 http://ctri.nic.in/Clinicaltrials, date of trial registration 19.12.2016, date of first patient enrolment 1 January 2017.What is Known:•Delayed cord clamping improves haematocrit, results in better haemodynamic stability, and decreases the need of transfusion in early infancy.•However, due to lack of evidence, potential risk of hyperbilirubinaemia, and exacerbation of anaemia (following delayed cord clamping), early cord clamping is the usual norm in Rh-alloimmunised infantsinfants.What is New:•Delayed cord clamping in Rh-alloimmunised infants improves haematocrit at 2 h of life without any increase in incidence of serious adverse effects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00431-020-03578-8DOI Listing
June 2020
-->