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Abstract Background Longitudinal single-cell sequencing experiments of patient-derived models are increasingly employed to investigate cancer evolution. In this context, robust computational methods are needed to properly exploit the mutational profiles of single cells generated via variant calling, in order to reconstruct the evolutionary history of a tumor and characterize the impact of therapeutic strategies, such as the administration of drugs. To this end, we have recently developed the LACE framework for the Longitudinal Analysis of Cancer Evolution. Results The LACE 2.0 release aimed at inferring longitudinal clonal trees enhances the original framework with new key functionalities: an improved data management for preprocessing of standard variant calling data, a reworked inference engine, and direct connection to public databases. Conclusions All of this is accessible through a new and interactive Shiny R graphical interface offering the possibility to apply filters helpful in discriminating relevant or potential driver mutations, set up inferential parameters, and visualize the results. The software is available at: github.com/BIMIB-DISCo/LACE.

Colchicine has been used since ancient times for gout and familial Mediterranean fever. Inflammation plays a major role in the pathogenesis of atherosclerosis thus paving a way for the use of anti-inflammatory drugs in the management of cardiovascular diseases (CVD). The role of colchicine in the management of pericarditis has been well established. It has been evident from clinical trials the beneficial effects of colchicine in various cardiovascular conditions such as coronary artery disease, atrial fibrillation, and postcardiotomy syndromes. The most frequently used dose of colchicine is 0.5 mg once a day, with duration varying according to clinical condition. The widespread availability, low cost and acceptable side effect profile has made colchicine an attractive therapeutic option. The aim of this article is to summarize colchicine's mechanism of action and evidence from various trials of its use in CVD in the current era.

Krishnan Chakravarthy,1,2 Natalie Strand,3 Anne Frosch,4,5 Dawood Sayed,6 Lakshmi Rekha Narra,1 Rahul Chaturvedi,1 Prabhdeep K Grewal,7 Jason Pope,8 Michael E Schatman,9,10 Timothy Deer11 1Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA; 2VA San Diego Healthcare System, San Diego, CA, USA; 3Department of Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA; 4Hennepin Healthcare Research Institute, Minneapolis, MN, USA; 5Department of Medicine, University of Minnesota, Minneapolis, MN, USA; 6Department of Anesthesiology and Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA; 7Pain Medicine, TSAOG Orthopaedics, San Antonio, TX, USA; 8Evolve Restorative Center, Santa Rosa, CA, USA; 9Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 10Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA; 11Department of Pain Medicine, The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Michael E Schatman Tel +1(425)647-4880Email Michael.Schatman@tufts.eduAbstract: To date, COVID-19 has spread to more than 108 million people globally, with a death toll surpassing 2 1/2 million. With the United States Food and Drug Administration (FDA) approval of two highly effective COVID-19 vaccines from Pfizer-BioNtech and Moderna, we now have a novel approach to contain COVID-19 related morbidity and mortality. Chronic pain care has faced unprecedented challenges for patients and providers in this ever-changing climate. With the approval of COVID-19 vaccines, we now face questions relating to the potential effects of pain treatments utilizing steroids on vaccine efficacy. In this analysis, we address these issues and provide guidance for steroid therapies based on available data and expert recommendations.Keywords: vaccines, chronic pain, interventional pain therapy, epidural steroid injections, COVID-19

Forty two year old female with rheumatoid arthritis presented with breathlessness on exertion. ECG was in sinus rhythm, right axis deviation of QRS, and poor progression of R wave. Echocardiogram showed right ventricular dilatation and apical crypts. Cardiac MRI confirmed the crypts and noncompaction of the right ventricle. Isolated noncompaction of right ventricle(NCRV) is very rare and is only mentioned in a few case reports. The embryology, diagnostic criteria extrapolated from the noncompaction of left ventricle, and the clinical course of NCRV are reviewed. This rare disease has been associated with rheumatoid arthritis for the first time.

Recreational use of Marijuna smoking is on the rise among the young and adolescents. This can result in worsening of angina or acute myocardial infarction in those with underlying coronary artery disease (CAD) due to sympathetic nervous system stimulation. Even those without CAD can present with acute coronary syndromes due to coronary spasm which can be confirmed by Coronary angiography by ruling out obstructive lesions in these cases . There is fivefold increase in symptoms during 1st hour after consumption. High chances of recurrence of symptoms when the drug is reused and patients needs to be counselled.

Thrombo-embolic complications after Corona virus disease-19 (COVID-19) vaccination have been previously reported. We aimed to study the coronary thrombo-embolic complications (CTE) after COVID-19 vaccination in a single centre during the initial 3 months of vaccination drive in India. All patients admitted to our hospital between 1st March 2021 and 31st May 2021 with Acute coronary syndrome (ACS) were included. Of the 89 patients [Age 55 (47-64)y, 13f] with ACS and angiographic evidence of coronary thrombus, 37 (42%) had prior vaccination history. The timing from last vaccination dose to index event was <1, 1-2, 2-4 and >4 weeks in 9(24%), 4(11%), 15(41%) and 9 (24%) respectively. ChAdOx1 nCoV-19/AZD1222 (Covishield) was the most used vaccine- 28 (76%), while 9 (24%) had BBV152 (Covaxin). Baseline characteristics were similar in both vaccinated (VG) and non-vaccinated group (NVG), except for symptom to door time [8.5 (5.75-14) vs 14.5 (7.25-24) hrs, p = 0.003]. Thrombocytopenia was not noted in any of the VG patients, while 2 (3.8%) of NVG patient had thrombocytopenia (p = 0.51). The pre- Percutaneous Coronary Intervention (PCI) Thrombolysis in Myocardial Infarction (TIMI) flow was significantly lower [1 (0-3) vs2 (1-3), p = 0.03) and thrombus grade were significantly higher [4 (2.5-5) vs 2 (1-3), p = 0.0005] in VG. The in-hospital (2.7% vs 1.9%, p = 1.0) and 30-day mortality were also similar (5.4% vs 5.8%, p = 1.0). This is the first report of CTE after COVID-19 vaccination during the first 3 months of vaccination drive in India. We need further reports to identify the incidence of this rare but serious adverse events following COVID-19 vaccination., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Aim: The impact of coronavirus disease 2019 (COVID-19) lockdown on cardiac emergency admissions to hospitals has been reported previously. We aimed to study the emergency room (ER) admissions to cardiac intensive care unit (CICU) at a tertiary care center during that period and compare this with admissions during the same time frame in the previous years., Materials and Methods: This is a retrospective observational study of patients admitted to the CICU during the pandemic period from March 22 to August 1 (inclusive) of 2020 and compared this with CICU admissions in the same time frame in the previous 2 years (2018 and 2019)., Results: During the study period in 2020, a total of 216 patients (age 59 ± 14 years) were admitted via ER, which is a 33% and 30% decline in admissions compared to 2019 ( n = 322, age 63 ± 12 years) and 2018 ( n = 307, age 62 ± 13), respectively. The decline in admissions with the primary diagnosis of acute coronary syndrome (ACS), acute decompensated heart failure, arrhythmia, and other diagnoses during the study period in 2020 were 27%, 38%, 62%, and 59%, respectively, while there was a 50% increase in acute pulmonary embolism admission compared to the mean admission in 2018 and 2019. Weekly admission rates gradually increased from less than 10 per week in the first 3 weeks to >15 by eighth week of the study period in 2020, while the trend was same throughout the study period in the previous 2 years. The CICU mortality rate in 2020 study period was 4.6% compared to 3.9% in 2018 ( p = 0.83) and 5.6% in 2019 ( p = 0.70). The in-hospital mortality of these patients was also similar in all 3 years (6.5%, 7.8%, and 7.9% in 2018, 2019, and 2020, respectively; p = 0.61)., Conclusion: Our study showed that CICU admissions during COVID-19 lockdown had declined compared to the previous years in a large tertiary center in India. Government and health organizations should educate the public early on during the pandemic about the consequences of ignoring other acute medical problems such as ACS, provide various measures for them to reach hospital early, and give reassurance with the best practices adopted in hospitals to avoid contracting the virus from the hospital environment., How to Cite This Article: Yalamanchi R, Dasari BC, Narra L, Oomman A, Kumar P, Nayak R, et al. Cardiac Intensive Care Unit Admissions during COVID-19 Pandemic-A Single Center Experience. Indian J Crit Care Med 2020;24(11):1103-1105., Competing Interests: Source of support: Nil Conflict of interest: None, (Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.)

Large volumes of heterogeneous health data silos pose a big challenge when exploring for information to allow for evidence based decision making and ensuring quality outcomes. In this paper, we present a proof of concept for adopting data warehousing technology to aggregate and analyse disparate health data in order to understand the impact various lifestyle factors on obesity. We present a practical model for data warehousing with detailed explanation which can be adopted similarly for studying various other health issues.

A patient who presented with a new apparent seizure was found to have abnormal electrocardiographic findings, with classic features of the Brugada syndrome. He had spontaneous episodes of nonsustained ventricular tachycardia, easily inducible ventricular fibrillation at electrophysiological study in the absence of structural heart disease, and a negative neurological evaluation. These findings suggested that sustained ventricular arrhythmias known to be associated with the Brugada syndrome and resultant cerebral hypoperfusion, rather than a primary seizure disorder, were responsible for the event. Patients with the Brugada syndrome often present with sudden death or with syncope resulting from ventricular arrhythmias. In consideration of its variability in presentation sometimes mimicking other disorders, primary care physicians and internists should be aware of its often transient electrocardiographic features.

Objective: To determine the early and late results of surgical treatment for infective endocarditis (IE) in intravenous drug users (IVDU)., Design: Cohort study of consecutive IVDUs undergoing surgical treatment for IE., Setting: Large public hospital serving the urban population of Chicago, Ill., Patients: Consecutive IVDUs operated on between July 1982 and June 1991 for IE., Main Outcome Measures: Death, stroke, noncerebral systemic embolization, major bleeding, recurrent endocarditis, and repeated valve replacement., Results: There were 80 patients, 58 men and 22 women, with a mean age of 37.5 +/- 10 (SD) years. The hospital course in all patients and follow-up data on 75 (94%) patients were complete. The primary indication for surgery was acute congestive heart failure in 44 (56%), persistent sepsis in 21 (26%), and multiple systemic embolization in 15 (19%) patients. Six patients (7.5%) died within 30 days of surgery. An additional 13 of 69 patients (17.6%) died during the follow-up, 8 from cardiovascular causes. The probability of survival at 36 months and at 60 months was 0.74 +/- 0.05 (SE) and 0.70 +/- 0.05, respectively. Seventeen (30%) of the survivors had at least one major cardiovascular event; 6 (8.8%) had recurrent endocarditis, 4 (5.8%) had stroke, 3 (4.4%) had extracerebral bleeding, 1 had extracerebral systemic embolism, and 3 (4.4%) required repeated valve replacement. Probability of event-free survival at 36 months and 60 months was 0.65 +/- 0.06 and 0.52 +/- 0.08, respectively. The median duration of event-free survival was 65 months., Conclusion: Since the expected mortality without surgery in patients with IE in whom medical treatment fails is almost 100%, it is concluded that surgical treatment is indicated for, and substantially improves the outlook for early and late survival of, IVDUs with IE who fail to respond to medical management.