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Effective management of neonatal respiratory distress requires timely recognition of when to transition from non-invasive to invasive ventilation. Although the lung ultrasound score (LUS) is useful in evaluating disease severity and predicting the need for surfactants, its efficacy in identifying neonates requiring invasive ventilation has only been explored in a few studies. This study aims to assess the accuracy of LUS in determining the need for invasive ventilation in neonates on non-invasive ventilation (NIV) support. From July 2021 to June 2023, we conducted a prospective study on 192 consecutively admitted neonates with respiratory distress needing NIV within 24 h of birth at our NICU in Hyderabad, India. The primary objective was the diagnostic accuracy of LUS in determining the need for invasive ventilation within 72 h of initiating NIV. We calculated LUS using the scoring system of Brat et al. (JAMA Pediatr 169:e151797, [10]). Treating physicians' assessments of the need for invasive ventilation served as the reference standard for evaluating LUS effectiveness. Out of 192 studied neonates, 31 (16.1%) required invasive ventilation. The median LUS was 5 (IQR: 2-8) for those on NIV and 10 (IQR: 7-12) for those needing invasive ventilation. The LUS had a strong discriminative ability for invasive ventilation with an AUC (area under the curve) of 0.825 (CI: 0.75-0.86, p = 0.0001). An LUS > 7 had 77.4% sensitivity (95% CI: 58.9-90.8%), 75.1% specificity (95% CI: 67.8-81.7%), 37.5% positive predictive value (PPV) (95% CI: 30.15-45.5%), 94.5% negative predictive value (NPV) (95% CI: 89.9-97.1%), 3.1 positive likelihood ratio (PLR) (95% CI: 2.2-4.3), 0.3 negative likelihood ratio (NLR) (95% CI: 0.15-0.58), and 75.5% overall accuracy (95% CI: 68.8-81.4%) for identifying invasive ventilation needs. In contrast, SAS, with a cutoff point greater than 5, has an AUC of 0.67. It demonstrates 62.5% sensitivity, 61.9% specificity, 24.7% PPV, 89.2% NPV, and an overall diagnostic accuracy of 61.9%. The DeLong test confirms the significance of this difference (AUC difference: 0.142, p = 0.04), underscoring LUS's greater reliability for NIV failure.  Conclusion: This study underscores the diagnostic accuracy of the LUS cutoff of > 7 in determining invasive ventilation needs during the initial 72 h of NIV. Importantly, while lower LUS values typically rule out the need for ventilation, higher values, though indicative, are not definitive. What is known? • The effectiveness of lung ultrasound in evaluating disease severity and the need for surfactants in neonates with respiratory distress is well established. However, traditional indicators for transitioning from non-invasive to invasive ventilation, like respiratory distress and oxygen levels, have limitations, underscoring the need for reliable, non-invasive assessment tools. What is new? • This study reveals that a LUS over 7 accurately discriminates between neonates requiring invasive ventilation and those who do not. Furthermore, the lung ultrasound score outperformed the Silverman Andersen score for NIV failure in our population., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aims: To evaluate the feto-maternal outcome, identify the adverse outcome predictors and test the applicability of modified WHO (mWHO) classification in pregnant women with heart disease (PWWHD) from Tamil Nadu, India., Methods and Results: One thousand and five pregnant women (mean age: 26.04 ± 4.2) with 1029 consecutive pregnancies were prospectively enrolled from July 2016 to December 2019 in the Madras medical college pregnancy and cardiac (M-PAC) registry. Majority (60.5%; 623/1029) had heart disease (HD) diagnosed for the first time during pregnancy. Rheumatic HD (42%; 433/1029) was most common. One third (34.2%; 352/1029) had pulmonary hypertension (PH). Maternal mortality and composite maternal cardiac events (MCEs) were the primary outcomes. Secondary outcomes were foetal loss and composite adverse foetal events (AFEs). MCEs occurred in 15.2% (156/1029; 95% CI: 13.0-17.5) pregnancies. Heart failure was the most common MCE (66.0%; 103/156; 95% CI: 58.0-73.4). Maternal mortality was 1.9% (20/1029; 95% CI: 1.1-2.8), with highest rates in patients with prosthetic heart valves (PHVs) (8.6%; 6/70). Left ventricular systolic dysfunction (LVSD), PHVs, severe mitral stenosis, PH and current pregnancy diagnosis of HD were independent predictors of MCE. The c-statistic of mWHO classification for predicting MCE and maternal death were 0.794 (95% CI: 0.763-0.826) and 0.796 (95% CI: 0.732-0.860). 91.2% (938/1029; 95% CI: 89.392.8) of pregnancies resulted in live births. 33.7% (347/1029; 95% CI: 30.8-36.7) of pregnancies reported AFEs., Conclusion: Maternal mortality is high in PWWHD from India. Highest death rates occurred in women with PHVs, PH and LVSD. The mWHO classification for risk stratification may require further adaptation and validation in India., Competing Interests: Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors report no relationships that could be construed as a conflict of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Prosthetic valve thrombosis (PVT) is a dreadful complication of mechanical prosthetic valves. Thrombolytic therapy (TT) for PVT is an alternative to surgery and currently making a leading role. This study compares TT with tenecteplase (TNK) and streptokinase (SK) head to head in patients with mitral PVT., Methods: In this single center, observational study, patients with mitral PVT diagnosed by clinical data, transthoracic echocardiography, transesophageal echocardiography, and fluoroscopy were included. After excluding patients with contraindications for thrombolysis, they were randomly assigned to receive either SK or TNK regimen. Patients were monitored for success or failure of TT and for any complications., Results: Among 52 episodes (47 patients with 5 recurrences) of mechanical mitral PVT, 40 patients were thrombolyzed with SK and 12 patients were thrombolyzed with TNK. Baseline characteristics including demographic profile, clinical and echocardiographic features, and valve types were not statistically significant between the groups. Complete success rate was 77.5% in SK group and 75% in TNK group (p=0.88). Partial success rate, failure rate, and major complications were not statistically significant between the two groups. Within 12h of therapy, TNK showed complete success in 33.3% of patients compared to 15% in SK group (p-value <0.02). Minor bleeding was more common in TNK group., Conclusion: Slow infusion of TNK is equally efficacious but more effective than SK in the management of mitral mechanical PVT. 75% to 77.5% of PVT patients completely recovered from TT and it should be the first line therapy where the immediate surgical options were remote., (Copyright © 2017. Published by Elsevier B.V.)

Left ventricle-right atrial communication could be congenital (Gerbode defect) or acquired as a complication of surgery or infective endocarditis and leads to volume overloading of pulmonary circulation. Two types, direct and indirect types are known depending on the involvement of septal tricuspid leaflet. Transcatheter closure of this defect is feasible and appears an attractive alternative to surgical management. Various devices like Amplatzer duct occluder I, II, Muscular ventricular septal defect device etc. have been used to close this defect. We report two patients, a preteen boy with direct left ventricle-right atrial communication as post operative complication and an adult female with indirect communication who underwent transcatheter closure with Cera duct occluder (Lifetech Scientific (Shenzhen), China)., (Copyright © 2017. Published by Elsevier B.V.)

Background: The close relationship between pleural space and pericardial space and the dependence of their pressure kinetics are well known. This study evaluates the effects of increased intra pleural pressure due to pleural effusion on cardiovascular system., Methods: Forty patients above the age of 12 who had massive unilateral/bilateral pleural effusion due to non-cardiac etiology were included in the study. Therapeutic thoracocentesis was done for massive pleural effusion. The echocardiographic parameters measured before and after thoracocentesis were compared., Results: Mean age of the patients 46.6 years. Out of 40 patients 8 were females (20%). 7 patients had right atrial collapse on echo. 85% of patients had significant flow velocity changes across both tricuspid valve and mitral valve during phases of respiration.11 patients (47.82%) had IVC compressibility of <50% during inspiration. Mean flow velocity respiratory variations across tricuspid valve before thoracocentesis and after thoracocentesis E 45.04 ± 10.3,32 ± 11.3% (p value <0.001), A 53.71 ± 28%, 32.08 ± 12.5% (p < 0.001) across mitral valve E 32.30 ± 12%, 19.78 ± 7.8% (p < 0.001), A 26 ± 11.2%, 21 ± 9.3% (p 0.006) across pulmonary artery 42.63 ± 31.3%, 17.70 ± 6.2% (p < 0.001), across aorta 21.57 ± 11.4%, 14.08 ± 7.6% (p < 0.001)., Conclusion: Large pleural effusion has a potential to cause adverse impact on the cardiovascular hemodynamics, which could manifest as tamponade physiology. Altered cardiac hemodynamics could be an important contributor in the mechanism of dyspnea in patients with large pleural effusion., (Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

In the title compound, C26H22N2O4, the central pyrrolidine ring adopts a twist conformation and the cyclo-pentane ring of the dihydro-acenapthylene group adopts an envelope conformation with the spiro C atom as the flap. The naphthalene ring system of the dihydro-acenaphthyl-ene group forms dihedral angles of 83.4 (9) and 61.3 (7)°, respectively, with the mean planes of the pyrrolidine and indole rings. The crystal packing is stabilized by inter-molecular C-H⋯O hydrogen bonds. The title compound is a diastereomer of a previously reported structure.

The title compound, C19H18O3, crystallizes with three mol-ecules (A, B and C) in the asymmetric unit. The carbonyl O atom shows positional disorder over two sites in mol-ecules A and B; the site-occupancy ratios are 0.76 (3):0.24 (3) and 0.86 (3):0.14 (3), respectively. The ethyl-ene fragments in each mol-ecule have an E conformation, while the C-O-C-C torsion angles indicate near planarity. The dihedral angles formed by the aromatic rings are 20.0 (1), 23.7 (1) and 16.1 (1)° for mol-ecules A, B and C, respectively. Intra-molecular C-H⋯O hydrogen bonds occur in each mol-ecule.

Left atrial thrombus in the presence of diseased mitral valve and atrial fibrillation is a well known entity. But it is very rare to occur in the presence of normal mitral valve apparatus. We report the case of a 36 year old female who presented with left atrial ball valve thrombus and normal mitral valve apparatus and underwent surgery. This patient with gangrene of right lower limb came for cardiac evaluation. She had infarct in left middle cerebral artery territory- ten months prior to this admission and was on treatment for infertility. She had atrial fibrillation. Emergency surgery to remove the thrombus should be considered given its potential life threatening embolic nature., (Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Isolated noncompaction of ventricular myocardium (INVM) is a genetic cardiomyopathy due to abnormal arrest in endomyocardial embryogenesis between fetal 5th and 8th week. Noncompaction of right ventricle alone is rare. Here we present one such case where a young man presented with progressive right heart failure and atrial fibrillation. Subsequent evaluation by echo and cardiac magnetic resonance imaging confirmed our diagnosis. The cardinal manifestations of INVM are heart failure, arrhythmia, and embolic events and our case presented with former two manifestations. Echocardiographic criteria for diagnosing INVM are discussed., (© 2012, Wiley Periodicals, Inc.)

The title compound, CH(7)N(4) (+)·C(4)H(3)O(4) (-), is a molecular salt in which the amino-guanidinium cations and fumarate monoanions are close to planar, with maximum deviations of 0.011 (1) and 0.177 (1) Å, respectively. The crystal packing is stabilized by inter-molecular N-H⋯O and O-H⋯O hydrogen bonds.

Acute and rapidly reversible left ventricular dysfunction may be triggered by various psychological and physical insults. This entity is now well known as stress cardiomyopathy or Takotsubu cardiomyopathy. Suicidal hanging involves intense emotional outburst and the act of hanging is an extreme physical stress. We report a case of rapidly reversible left ventricular dysfunction following attempted suicide by hanging. Usually the outcome is favourable as in our case. The pathogenesis of left ventricular dysfunction in hanging is myocardial stunning due to catecholamine surge. Other mechanisms are also proposed.

Background and Aim of the Study: Rheumatic fever (RF) and chronic rheumatic heart disease (RHD) are common in developing countries. Two-thirds of RHD patients are school-children aged between 5 and 15 years. Pre-schoolers aged <5 years are not immune to RF however, and to date RHD patterns in this very young age group have not been studied systematically., Methods: Records of all RHD patients seen at the authors' institution between January 1999 and December 2000 were retrospectively reviewed. A special analysis was conducted among pre-school children aged <5 years., Results: Thirty-eight (6.8%) of the RF/RHD admissions were aged <5 years, and 28 of these patients (20 males, 8 females) presented with acute RF. The mean age of acute RF diagnosis was 4 years. All RF/RHD patients aged <5 years were in normal sinus rhythm. Joint pain and swelling (25 cases; characteristic migratory polyarthritis in six, monoarthritis in five) and fever (24 cases) were the most frequent symptoms. Arthritis, carditis and chorea occurred in 75%, 50% and 4% respectively, with no instances of erythema marginatum or subcutaneous nodules. Effort intolerance, chest discomfort and palpitations were reported by nine, five and three cases, respectively. Mitral regurgitation was the most common valvular lesion in RF. The youngest case of confirmed acute RF was an 18-month-old male. The only patient with mitral stenosis in the present series was a 4-year-old girl. None of the patients required surgical intervention, and there were no deaths., Conclusion: RHD is common in very young age groups of <5 years. Pre-schoolers account for a significant proportion of acute RF and chronic RHD admissions among children. Mitral regurgitation is the most common cardiac manifestation, but obstructive valve disease is distinctly rare in this age group. Aortic regurgitation, left ventricular dysfunction and pulmonary hypertension may complicate the course of RF in these very young children.