Search

Objectives: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. Methods: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. Results: Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. Conclusion: The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.

Conduction abnormalities are commonly noted after alcohol septal ablation (ASA). This was a retrospective, observational study where we studied the incidence of new onset conduction abnormalities post ASA. 23 patients, who underwent ASA over a period of 5 years, were included in the study. Baseline conduction abnormalities were noted in 26% patients (n = 6). Transient complete heart block (CHB) was noted in 21.7% (n = 5) whereas new onset right bundle branch block (RBBB) was seen in 60.8% (n = 14). Left bundle branch block was uncommon (4.3%,n = 1). Permanent pacemaker implantation was done in 4.3% (n = 1) for CHB. Conduction anomalies are frequent after ASA with RBBB being most common.

Background: The role of late gadolinium enhancement (LGE) in cardiac MRI (CMR) as prognostic marker in non-ischemic dilated cardiomyopathy (NIDCM) is evolving. Objective: To study the effect of LGE in the prognosis of NIDCM patients. Methods: 112 consecutive NIDCM patients, who underwent CMR, were prospectively followed up for 745 ± 320 days. Primary end point was occurrence of MACE {composite of all-cause mortality, resuscitated cardiac arrest, sustained ventricular tachycardia (VT)/appropriate ICD shock, heart failure (HF) hospitalization}. Results: LGE was present in 44 out of 112 patients (39%). The primary end point (MACE) was significantly higher in LGE + ve group compared to the LGE –ve group (72.7% vs. 29.4%; p 14% of LV predicted MACE with 90.6% sensitivity and 86% specificity. HR of LGE extent >14% of LV for MACE is 6.12; p 14% of LV volume were strongest predictor of MACE. Conclusion: LGE and its extent >14% predicts adverse cardiac events in NIDCM irrespective of LVEF and LGE location, pattern or distribution. This study emphasises the role of CMR in risk stratification of NIDCM patients and guiding therapy.

Background. Follicular carcinoma thyroid usually metastasises to bone. Common sites of bone metastasis include skull and spine. Spinal metastasis are more common in the cervical region followed by dorsolumbar spine. Cervical extradural lesions present with progressive quadriparesis, sensory loss, dysautonomia, and respiratory distress. Typical Elsberg phenomenon in a cervical extradural lesion is rare. Elsberg phenomenon involves the involvement of ipsilateral upper limb, ipsilateral lower limb followed by contralateral lower limb and contralateral upper limb. Case presentation. We are reporting a case of 47-year-old lady presented with progressive quadriparesis of 1-month duration. Her weakness started in left upper limb followed by left lower limb, right lower limb and right upper limb weakness. She also had sensory loss below the level of C7. She had undergone near-total thyroidectomy for solitary thyroid nodule 14 years back and was on thyroid supplementation since then. Histopathology at that time was reported as follicular adenoma with Hashimoto thyroiditis. Her right upper limb power was grade 4- Left upper limb grade 1 right lower limb Grade 3, left lower limb grade 2 with hypertonia of both upper and lower limbs. She was evaluated with MRI Spine which showed a dumb bell-shaped extramedullary lesion involving the C5-C6 vertebra with significant cord compression and encasement of the left vertebral artery. USG neck showed left supraclavicular lymph node enlargement and small residual thyroid tissue in the left side of the thyroid. USG guided FNAC from the thyroid tissue and neck nodes were inconclusive. The patient underwent C4 and C5 laminectomy and subtotal excision from the cervical lesion. Histopathology was reported as metastasis from follicular carcinoma thyroid. Postoperatively patient limb power improved to grade 3 left upper and lower limbs and was discharged and later referred for radioiodine ablation Conclusion. Cervical extradural metastasis from follicular carcinoma thyroid can present with Elsberg syndrome even without any neck swelling even after decades of post thyroidectomy status for a benign aetiology. Laminectomy and decompression may lead to clinical improvement.

There are limited studies on heart failure in Indian population Objective: Present study aimed to assess the in-hospital 90-day and two year outcomes in patients with ischemic (IHD-HF) and non ischemic heart failure (NIHD-HF). Methods: Patients with NYHA Class III & IV, who were admitted to our intensive care unit with heart failure (HF), were evaluated and followed up for 2 years. Results: In our cohort of 287 patients, there were 192 (66.9%) males and 95 (33.1%) females. Patients were divided into IHD-HF of 180 (62.7%) patients and NIHD-HF of 107 (37.3%) patients. Mean age of IHD-HF group was 66 (+/−10) and in the NIHD-HF group was 61 (+/−11). Prevalence of HF increased with age in the IHD-HF population and there was no relation with age in the NIHD-HF population .Patients readmitted within 90 days in the IHD-HF were 56 % (n−101) and in the NIHD-HF were 32.7 % (n-35) [p- 0.001]. Two- year recurrent admissions were 69.4 % (n-125) in the IHD-HF patients and 52.3 % (n-56) in the NIHD-HF patients, respectively (p-0.004). Mortality at 90 days in the IHD-HF patients was 26.6 % (n-48) and in NIHD-HF patients were 14.9 % (n-16) [p- 0.021]. Two-year mortality was 42.3 % (n-76) in the IHD-HF patients and 29.9 %(n-32) in the NIHD-HF patients, respectively (p-0.037). Conclusions: HF in IHD-HF heralds a bad prognosis with recurrent hospitalizations and high mortality when compared to patients with NIHD-HF. Keywords: Heart failure, Recurrent admissions, Mortality

The cubic intermetallic compound Sm 3Co 4Ge 13 (space group P m 3 ¯ n ) possesses a cage-like structure composed of Ge and displays an antiferromagnetic transition at T N ≈ 6 K in magnetization, M ( T ) , specific heat, C p ( T ) and in thermal conductivity, κ ( T ). The magnetic transition at T N is observed to be robust against applied magnetic fields up to 9 T. From the analysis of specific heat, a Sommerfeld coefficient γ = 80(2) mJ/mol-Sm K 2 is estimated. The magnetic entropy released at T N is estimated as lower than that of a doublet, R ln(2). A positive Seebeck coefficient is observed for the thermopower, S ( T ) . Photoemission spectroscopy reveals distinct electronic character of the near-E F valence band states arising out of Co( 3 d)-Sm( 4 f) hybridization and Sm( 4 f) electron correlation. The unusual field-independent features in magnetization, specific heat and electrical transport is an indication of the significant correlation between f and d wave functions.

We report on the crystal growth of rare-earth pyrosilicates, R 2Si 2O 7 for R = Yb and Er using the optical floating zone method. The grown crystals comprise members from the family of pyrosilicates where the rare-earth atoms form a distorted honeycomb lattice. C-Yb 2Si 2O 7 is a quantum dimer magnet with field-induced long range magnetic order, while D-Er 2Si 2O 7 is an Ising-type antiferromagnet. Both growths resulted in multi-crystal boules, with cracks forming between the different crystal orientations. The Yb 2Si 2O 7 crystals form the C-type rare-earth pyrosilicate structure with space group C 2 / m and are colorless and transparent or milky white, whereas the Er-variant is D-type, P 2 1 / b , and has a pink hue originating from Er 3 +. The crystal structures of the grown single crystals were confirmed through a Rietveld analysis of the powder X-ray diffraction patterns from pulverized crystals. The specific heat of both C-Yb 2Si 2O 7 and D-Er 2Si 2O 7 measured down to 50 mK indicated a phase transition at T N ≈ 1.8 K for D-Er 2Si 2O 7 and a broad Schottky-type feature with a sharp anomaly at 250 mK in an applied magnetic field of 0.8T along the c-axis in the case of C-Yb 2Si 2O 7 .

Background : Selecting the device size using a sizing balloon could oversize the ostium secundum atrial septal defect (OSASD) with floppy margins and at times may lead to complications. Identifying the firm margins using trans-esophageal echocardiography (TEE) and selecting appropriate-sized device optimizes ASD device closure. This retrospective study was undertaken to document the safety and feasibility of device closure without balloon sizing the defect. Methods : Sixty-one consecutive patients who underwent trans-catheter closure of OSASD guided by balloon sizing of the defect and intra procedural fluoroscopy (group I) and 67 consecutive patients in whom TEE was used for defect sizing and as intraprocedural imaging during device deployment (group II) were compared. The procedural success rate, device characteristics, and complications were compared between the two groups. Results : The procedure was successful in 79.7 % patients. The success rate in group II (60 of 67, 89.6%) was significantly higher than in group I (41 of 61, 67.2 %) (P = 0.002). Mean upsizing of ASD device was significantly lower in group II (P < 0.001). TEE also provided better success rate with smaller device in subjects with large ASD (>25 mm) and in those who were younger than 14 years of age. There were four cases of device embolization (two in each group); of which one died in group II despite successful surgical retrieval. Conclusion : Balloon sizing may not be essential for successful ASD device closure. TEE-guided sizing of ASD and device deployment provides better success rate with relatively smaller sized device.

A rare case of Groenblad Strandberg syndrome in which angioid streaks are associated with pseudoxanthoma elasticum is being reported. The pathology, clinical features, complications and treatment of angioid streaks are discussed in detail.