Search

Abstract Background Rapid diagnostic tests (RDTs) have revolutionized the diagnosis of malaria. Among the various factors affecting RDTs sensitivity is genetic variation of the antigen used. The genetic variation in PfHRP2 and PfHRP3 proteins was studied among the Indian Plasmodium falciparum isolates. Methods One hundred and forty isolates of P. falciparum were collected from six geographical regions of India. Target genes encoding PfHRP2 and PfHRP3 antigens were sequenced to study genetic polymorphism. Minimum detection limit giving a positive rapid diagnostic test was also determined. Results Extensive variations were observed in amino acid repeat types of PfHRP2 and PfHRP3. PfHRP2 exhibited more polymorphism than PfHRP3. Significant relation was observed between type 2 and type 7 repeats and RDT detection rate as higher number of these repeats showed better sensitivity with RDTs. Conclusion The results provide insights into the genetic diversity of Pfhrp2 and Pfhrp3 genes among Indian P. falciparum population and its relation to RDT sensitivity.

Like several indigenous populations, Sauria Paharias, a vulnerable indigenous tribal group residing in a biodiverse environment of Jharkhand, India, have high levels of undernutrition. We assessed agroforestry and dietary diversity, food consumption especially indigenous food (IF) intake and nutritional status of Sauria Paharia women through a cross‐sectional study conducted in 18 villages of Godda district, Jharkhand. Household level information was elicited through household surveys including a dietary survey and a food frequency questionnaire. Twenty‐four‐hour dietary recalls (24 HDR) and anthropometric assessments were taken on one randomly selected woman per household. An index, Food Accessed Diversity Index (FADI) created to measure agroforestry diversity, showed a low mean score of 0.21 ± 0.15 and range: 0, 0.85. Fifty‐nine percent of women consumed any IF during 24 HDR. Median minimum dietary diversity score for women (MDD‐W) was 3 (acceptable score ≥5). More than 96% of women had intakes below estimated average requirements for all nutrients studied (energy; vitamins A, C, thiamine, riboflavin, niacin, pyridoxine; folate; iron; calcium and zinc) except protein; 41% women were underweight. IF consumption was independently associated with calcium and vitamin A intake. Decision trees developed for micronutrient consumption at different levels of MDD‐W score and IF consumption scenarios revealed 1.3 to 2.9 times higher consumption of micronutrients among women with MDD‐W ≥ 3 or 4. Strategies like agricultural extension programmes promoting indigenous varieties and nutrition education for increasing dietary diversity with IFs have potential to address undernutrition in Sauria Paharia women. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation treated with cryoballoon ablation relies on pulmonary contrast venography (CV) to confirm vein occlusion prior to delivery of ablative therapy. Pulmonary pressure waveform monitoring (PWM) offers an alternative, contrast-free, method of assessing pulmonary vein occlusion. Prior studies have not compared the procedural differences and outcomes following application of these two techniques. Hypothesis: We hypothesized that there would be no difference in freedom from atrial fibrillation at 6 months following pulmonary vein isolation with PWM compared with CV. Methods: Subjects who underwent cryoballoon ablation for atrial fibrillation after pulmonary vein isolation with either PWM (n=18) or CV (n=18) between 1/1/2016 and 1/31/2018 were included in this study. Baseline demographic information, procedural and outcomes data following a 3-month blanking period were collected for all subjects. Results: The average age of the PWM cohort was 62.2±9.0 years compared to 63.9±5.9 years for the CV group (p=0.50). Cryoballoon ablation procedures were performed entirely without contrast in the PWM group while the CV group received on average 49.6±15mg of contrast (p<0.001). Creatinine did not change significantly pre to 24-hours post-procedure within either cohort (Table 1). The CV cohort received a significantly higher number of cryoballoon applications (8.8 ± 1.5 vs 6.8 ± 1.9, p<0.001) leading to increased procedural duration (3.88 ± 0.51 vs 3.28 ± 0.62 hours, p=0.008). At 6 months post-procedure, 2 subjects in the CV group suffered recurrent atrial fibrillation while all subjects in the PWM group remained recurrence free (p=0.467). Conclusions: Pressure waveform monitoring introduces a novel, non-inferior method to demonstrate pulmonary vein occlusion prior to cryoballoon ablation procedures. This technique may expand the utility of cryoballoon ablation to patients with renal impairment and contrast allergy. [ABSTRACT FROM AUTHOR]

Purpose: Shared decision-making (SDM) is a method for a patient and physician to cooperatively consider a diagnostic or therapeutic option, ultimately empowering the patient to make an informed decision. Atrial fibrillation (AF) ablation is a procedure that would benefit from SDM given the risk of serious adverse events, the high rate of arrhythmia recurrence, and alternative treatment options. Implementing a patient decision aid (PDA) may help facilitate AF ablation SDM by succinctly conveying important information to patients., Methods: Patients scheduled for initial AF catheter ablation were randomized to a virtual SDM visit utilizing a PDA, which covered procedural risks and benefits, or a virtual control visit with a tool outlining periprocedural processes. Preoperatively, patients completed a questionnaire assessing procedural risk and benefit knowledge, as well as perceived involvement with the decision-making process. Unpaired t-tests were used to compare groups., Results: The SDM group scored significantly better overall on knowledge-based questions compared to the control group (69% correct [n=34] vs 53% [n=32]; P=0.00013). In particular, the SDM group was significantly more likely to answer questions correctly about stroke risk (P=0.01), anticoagulation (P=0.01), and potential need for additional procedures (P=0.03 and P=0.03). Perceived involvement in the decision-making process was overall not improved with PDA use (4.7 vs 4.6 out of 5; P=0.72)., Conclusions: The addition of a PDA for AF ablation significantly improved procedural knowledge but did not impact patients' perceived involvement in the decision-making process compared to traditional preprocedural discussion alone., Competing Interests: Conflicts of Interest: None., (© 2024 Advocate Aurora Health, Inc.)

The epidemiological necessity for distancing during the COVID-19 pandemic has resulted in postponement of non-emergent hospitalizations and increase use of telemedicine. The feasibility of virtual antiarrhythmic drug (AAD) loading specifically with digital QTc electrocardiographic monitoring (EM) in conjunction with telemedicine video visits is not well established. We tested the hypothesis that existing digital health technologies and virtual communication platforms could provide EM and support medically guided AAD loading for patients with symptomatic tachyarrhythmia in the ambulatory setting, while reducing physical contact between patient and healthcare system. A prospective pilot, case series was approved by the institutional ethics committee, entailing three subjects with symptomatic arrhythmia during the COVID-19 pandemic who were enrolled for virtual AAD loading at home. Clinicians met with participants twice daily via video visits conducted after QTc analysis (Kardia 6L mobile sensor) and telemetry review (Mobile Cardiac Outpatient Telemetry of silent arrhythmias). Participants received direct instruction to either terminate the study or proceed with the next single dose of AAD. All participants completed contactless loading of five AAD doses, without untoward event. Scheduled video visits allowed dialogue and participant counselling where decision-making was guided by remote review of EM. Participant adherence with transmissions and scheduled visits was 98.3%; a single electrocardiogram was delayed beyond the 2 hours of post-dose schedule. This virtual approach reduced overall expenditures based on retrospective comparison with previous AAD load hospitalizations. We found that a 'virtual hospitalization' for AAD loading with remote EM and twice-daily virtual rounding is feasible using existing digital health technologies., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)