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Aspirin is the most used antiplatelet agent for secondary prophylaxis of atherosclerotic cardiovascular diseases. Individual variability in aspirin responsiveness has been widely reported. The current recommendations do not take these variations into consideration. Current guidelines recommend 75–100 mg of once-daily aspirin in all patients for secondary prevention. However, “one-dose-fits-all” may not be the appropriate aspirin dosing strategy. Based on our review, we suggest that patients with inadequate aspirin responsiveness are at increased risk of recurrent cardiovascular events. Noncompliance is the most common cause of poor aspirin response. Ensuring adequate compliance and avoiding concomitant ingestion of nonaspirin nonsteroidal anti-inflammatory drugs and bedtime ingestion of aspirin can help achieve adequate aspirin-mediated antiplatelet activity. A low-dose, twice-daily regimen is the preferred strategy in “high-risk” groups.

Suraj Singh Senjam,1 Yatan Pal Singh Balhara,2 Pameshwar Kumar,3 Neeraj Nischal,4 Souvik Manna,1 Karan Madan,5 Nishat Hussain Ahmed,1 Noopur Gupta,1 Praveen Vashist,1 Randeep Guleria5 1Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 2Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India; 3Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India; 4Department of Medicine, All India Institute of Medical Sciences, New Delhi, India; 5Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Suraj Singh Senjam, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Tel +91-011-2659-3032 ; +91 9968856431, Email drsurajaiims@gmail.comPurpose: With millions of people being affected by COVID-19, people living with post COVID-19 clinical symptoms (PCS) are expected to rise further. The primary aim of the study was to comprehensively assess self-reported PCS and its associated risk factors among beneficiaries of Hospital Employee Scheme of a tertiary healthcare institution in Delhi.Patients and Methods: An online cross-sectional study was conducted using a semi-structured questionnaire developed by employing nominal group technique among individuals aged 18 years and above who were novel SARS-CoV-2 positive from January to April 2021. Participants were telephoned first, before sending the online survey link. Socio-demographic data, information on PCS along with potential risk factors, pre-existing morbidities, vaccination status, severity of acute illness and management were collected between June and July 2021. PCS was presented as relative frequency; Chi-Square test and odds ratio; adjusted values were used to rule out any association between PCS and predictors.Results: In total, 773 of 1801 eligible participants responded to the survey (completion rate 42.9%), with a median age of 34 years (IQR 27– 44). Males accounted for 56.4% and PCS was present in 33.2%. The most prevalent symptoms were fatigue (79.3%), arthralgia (33.4%), myalgia (29.9%), hair loss (28.0%), headache (27.2%), breathlessness (25.3%), and sleep disturbance (25.3%). The prevalence of PCS was reduced to 12.8% at 12 weeks. Female gender, older age, oxygen supplementation, severity of acute illness, and pre-existing co-morbidities were positively associated with PCS. Vaccination (second dose) reduced the odds of developing PCS by 39% compared to unvaccinated participants (aOR 0.61; 95% CI 0.40– 0.96).Conclusion: PCS affects almost all organ systems of the body, regardless of the severity of acute COVID-19 illness. Two doses of vaccine hel reduce the development of PCS.Keywords: COVID-19, post COVID-19 symptoms, long COVID-19, cross-sectional study, Northern India

BackgroundA single-daily dose of 75 mg of acetylsalicylic acid inhibits 100% of thromboxane-B2 synthesis within 30–60 min. Thromboxane-B2 synthesis then recovers slowly as new platelets are released from the bone marrow. Normally, only 10% of the platelets are replaced daily by new platelets entering circulation. Hence, 24 h after a dose of acetylsalicylic acid, thromboxane-B2 synthesis is still suppressed by more than 90%. Hence, there is an adequate anti-platelet effect even after 24 h of acetylsalicylic acid intake. However, some patients treated with once-daily acetylsalicylic acid may have an incomplete 24-h suppression of thromboxane-B2 synthesis due to increased platelet turnover. The response could be improved in such patients by twice-daily acetylsalicylic acid administration. This study aimed to identify such a group of patients who would benefit from a twice-daily dose of acetylsalicylic acid.Materials and methodsSerum thromboxane-B2 levels were measured in 79 patients with coronary artery disease receiving 75 mg of acetylsalicylic acid for secondary prophylaxis. Serum levels of thromboxane-B2 were measured after 4 and 24 h of acetylsalicylic acid intake. Patients were then classified into three groups: steady suppression group (serum thromboxane B2 is adequately suppressed at 4 and 24 h), i.e., adequate response to acetylsalicylic acid; fast recovery group (more than 10% rise in serum thromboxane-B2 levels at 24-h when compared to at 4-h) and non-responders (serum thromboxane-B2 levels of >3,100 pg/ml after 4 h of acetylsalicylic acid intake). Patients in the fast recovery group were given twice-daily acetylsalicylic acid and thromboxane-B2 levels were re-measured.ResultsA total of 20 patients (24.3%) had steady suppression of thromboxane-B2 and 11 patients (13.9%) belonged to the fast recovery group, i.e., thromboxane-B2 levels were adequately suppressed at 4 h but had recovered by more than 10% at 24 h; which was adequately suppressed by twice-daily acetylsalicylic acid (p 0.004). A total of 48 patients (60.8%) were non-responders.ConclusionTwice-daily acetylsalicylic acid may be beneficial if serum thromboxane-B2 levels at 4 h are 3,100 pg/ml at 24 h. If thromboxane-B2 levels at 4 and 24 h is 10% rise in serum thromboxane B2 at 24 h as compared to that at 4 h, then twice-daily acetylsalicylic acid should be considered. However, if thromboxane-B2 at 4 and 24 h is >3,100 pg/ml consider switching over to a P2Y12 inhibitor.

Background/objectives Heart failure (HF) is a growing clinical and economic burden for patients and health systems. The COVID-19 pandemic has led to avoidance and delay in care, resulting in increased morbidity and mortality among many patients with HF. The increasing burden of HF during the COVID-19 pandemic led us to evaluate the quality and safety of the Hospital at Home (HAH) for patients presenting to their community providers or emergency department (ED) with symptoms of acute on chronic HF (CHF) requiring admission.Design/outcomes A non-randomised prospective case–controlled of patients enrolled in the HAH versus admission to the hospital (usual care, UC). Primary outcomes included length of stay (LOS), adverse events, discharge disposition and patient satisfaction. Secondary outcomes included 30-day readmission rates, 30-day ED usage and ED dwell time.Results Sixty patients met inclusion/exclusion criteria and were included in the study. Of the 60 patients, 40 were in the HAH and 20 were in the UC group. Primary outcomes demonstrated that HAH patients had slightly longer LOS (6.3 days vs 4.7 days); however, fewer adverse events (12.5% vs 35%) compared with the UC group. Those enrolled in the HAH programme were less likely to be discharged with postacute services (skilled nursing facility or home health). HAH was associated with increased patient satisfaction compared with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score in North Carolina. Secondary outcomes of 30-day readmission and ED usage were similar between HAH and UC.Conclusions The HAH pilot programme was shown to be a safe and effective alternative to hospitalisation for the appropriately selected patient presenting with acute on CHF.

Belly dancer’s dyskinesia or syndrome is a rare condition characterized by involuntary, undulating, infrequent diaphragm movements. The etiologies for this disorder include nervous system disorders (peripheral or central), drug-induced, psychological, or idiopathic. This article describes a 10-year-old boy with an underlying psychological stressor who suddenly experienced involuntary abdominal wall movements after salbutamol nebulization. After a detailed history, physical examination, and abdominal ultrasound that revealed rapid rhythmic diaphragm movements, the child was diagnosed with salbutamol-induced belly dancer's dyskinesia with an underlying psychological problem. These movements subsided with medical and psychological therapy for two weeks. Belly dancer’s dyskinesia is a complex disorder that is difficult to diagnose but can be managed with medical treatment and psychological counseling alone in a few patients. In contrast, in other cases, surgical intervention may be required.

This paper discusses the solar cycle variation of the DE3 and DE2 nonmigrating tides in the nitric oxide (NO) 5.3 μm and carbon dioxide (CO2) 15 μm infrared cooling between 100 and 150 km altitude and ±40° latitude. Tidal diagnostics of SABER NO and CO2 cooling rate data (2002–2013) indicate DE3 (DE2) amplitudes during solar maximum are on the order of 1 (0.5) nW/m3 in NO near 125 km, and on the order of 60 (30) nW/m3 in CO2 at 100 km, which translates into roughly 15–30% relative to the monthly zonal mean. The NO cooling shows a pronounced (factor of 10) solar cycle dependence (lower during solar minimum) while the CO2 cooling does not vary much from solar min to solar max. Photochemical modeling reproduces the observed solar cycle variability and allows one to delineate the physical reasons for the observed solar flux dependence of the tides in the infrared cooling, particularly in terms of warmer/colder background temperature versus smaller/larger tidal temperatures during solar max/min, in addition to cooling rate variations due to vertical tidal advection and tidal density variations. Our results suggest that (i) tides caused by tropospheric weather impose a substantial—and in the NO 5.3 μm case solar cycle dependent—modulation of the infrared cooling, mainly due to tidal temperature, and (ii) observed tides in the infrared cooling are a suitable proxy for tidal activity including its solar cycle dependence in a part of Earth's atmosphere where direct global temperature observations are lacking. Key Points: Large solar cycle effect is seen in NO cooling rate tide due to temperature, but tidal advection shows increasing contribution over solar minCO2 cooling rate tides are more important during solar min, but NO tides become more important during solar max above 125Tides in IR cooling rates are suitable proxy for height evolution of tidal spectrum in the thermosphere [ABSTRACT FROM AUTHOR]

Recognizable vascular skin manifestations of SARS-CoV-2 (COVID-19) infection are uncommon in patients with darker skin phototypes Reported cutaneous manifestations of SARS-Cov-2 infection include maculopapular rash, urticarial rash, varicelliform or vesicular lesions, petechiae/purpura, livedoid/necrotic lesions, chilblain-like lesions ("COVID toes"), erythema multiforme-like lesions1 and aphthous ulcers.2 These cutaneous manifestations have been mostly reported from countries with populations of lighter skin phototypes, with a paucity of data from the populations with darker skin phototypes.3 We conducted a prospective study to report the prevalence and patterns of cutaneous manifestations in patients with COVID-19 from India. All 10 patients had Fitzpatrick skin types IV or V. In all our patients, the cutaneous features followed the symptoms of COVID-19. 1 TableDetails of the patients possible COVID-19-related cutaneous features included in the study. [Extracted from the article]

Abstract Symptoms of Guillain–Barre Syndrome (GBS) may be mistaken for typical puerperal changes, delaying diagnosis. Surgery and anesthesia may be triggers for GBS with an overall increase in pro‐inflammatory cytokines in the postpartum period. We report a unique case of GBS in the postpartum period who made a good recovery with supportive measures.

Abstract Background Despite the literature on acute Achilles tendon ruptures, there remains a lack of consensus regarding the optimal treatment. The purpose of this survey study was to investigate treatment preferences among Army orthopaedic surgeons when presented with a standardized case of an acute Achilles rupture and determine if surgeon factors correlated with treatment preference. Methods A hypothetical case of a 37-year-old male with history, physical exam, and imaging consistent with an Achilles rupture was sent to board-certified Army orthopaedic surgeons to determine their preferred management. Demographic data was collected to include: practice setting, years from residency graduation, and completion of fellowship. Correlations analyzed between demographics and treatment preferences. Results Sixty-two surgeons responded. 62% of respondents selected surgical intervention. Of these, 59% chose a traditional open technique. 50% of respondents were general orthopaedic. There was a correlation between fellowship training and operative management (P = 0.042). Within the operative management group there was no statistical difference (P > 0.05) in need for further imaging, technique used, post-operative immobilization, length of immobilization, weight-bearing protocol, and time to release to running. The majority of non-operative responders would splint/cast in plantarflexion or CAM boot with heel lift for

Abstract Apart from the usual differentials of transverse myelitis and cord compression, paraparetic GBS should be considered when sudden, flaccid paralysis of the lower limbs occurs, as prompt diagnosis and management can minimize sequel and unnecessary procedures. We do report a case wherein we managed a similar situation without the use of an immunomodulatory therapy.