Percutaneous Closure of Perimembranous Ventricular Septal Defect with Amplatzer Device

Background

The Amplatzer perimembranous ventricular septal occluder is an innovative device for percutaneous closure of perimembranous ventricular septal defects (PMVSD). In appropriately selected cases this procedure is safe and effective.

Methods

Fourteen patients with the mean age 10.53 years (range 18 months to 55 years) and mean body weight 20.64 kg (range 6 to 52 kg) underwent PMVSD closure.

Result

The PMVSD mean diameter was 5.28 mm (range from 4 to 9 mm). Implantation was successful in 92% of the cases and all patients had complete occlusion of the shunt within three months.

Conclusion

Device orientation was excellent in all cases. Device-related aortic insufficiency, tricuspid insufficiency or left ventricular dysfunction was not observed. One patient had embolisation of the device and another had complete heart block which required a permanent pacemaker implantation. The excellent short term results need to be confirmed over long-term follow-up.Key Words: Perimembranous ventricular septal defect, Arrhythmias, Percutaneous closure     

Parenteral nutrition support: Beyond gut feeling? Quality control study of parenteral nutrition practices in a Tertiary Care Hospital

Background:Enteral nutrition (EN) is preferred over parenteral nutrition (PN) in hospitalized patients based on International consensus guidelines. Practice patterns of PN in developing countries have not been documented.Objectives:To assess practice pattern and quality of PN support in a tertiary hospital setting in Chennai, India.Methods:Retrospective record review of patients admitted between February 2010 and February 2012.Results:About 351,008 patients were admitted to the hospital in the study period of whom 29,484 (8.4%) required nutritional support. About 70 patients (0.24%) received PN, of whom 54 (0.18%) received PN for at least three days. Common indications for PN were major gastrointestinal surgery (55.6%), intolerance to EN (25.9%), pancreatitis (5.6%), and gastrointestinal obstruction (3.7%).Conclusions:The proportion of patients receiving PN was very low. Quality issues were identified relating to appropriateness of indication and calories and proteins delivered. This study helps to introspect and improve the quality of nutrition support.     

Prospective study of the incidence of serious posterior maxillary haemorrhage during a tuberosity osteotomy in low level Le Fort I operations

The incidence of serious haemorrhage in Le Fort I osteotomy is low and attempts to reduce this further have led to the development of various techniques to minimise vascular injury. This includes the tuberosity osteotomy and was published over two decades ago. This technique has not been widely adopted as shown by a recent UK survey of consultants, which suggested that only 12 (7%) of the 175 surgeons who responded, routinely use tuberosity osteotomy in non-cleft low level Le Fort I procedures. The aim of the study was to examine prospectively the incidence of serious haemorrhage from the posterior maxilla during tuberosity osteotomy. We report 35 consecutive patients who have had no operative or postoperative vascular complications.     

Precision Medicine for CRC Patients in the Veteran Population: State-of-the-Art,Challenges and Research Directions

Colorectal cancer (CRC) accounts for ~9% of all cancers in the Veteran population, a fact which has focused a great deal of the attention of the VA’s research and development efforts. A field-based meeting of CRC experts was convened to discuss both challenges and opportunities in precision medicine for CRC. This group, designated as the VA Colorectal Cancer Cell-genomics Consortium (VA4C), discussed advances in CRC biology, biomarkers, and imaging for early detection and prevention. There was also a discussion of precision treatment involving fluorescence-guided surgery, targeted chemotherapies and immunotherapies, and personalized cancer treatment approaches. The overarching goal was to identify modalities that might ultimately lead to personalized cancer diagnosis and treatment. This review summarizes the findings of this VA field-based meeting, in which much of the current knowledge on CRC prescreening and treatment was discussed. It was concluded that there is a need and an opportunity to identify new targets for both the prevention of CRC and the development of effective therapies for advanced disease. Also, developing methods integrating genomic testing with tumoroid-based clinical drug response might lead to more accurate diagnosis and prognostication and more effective personalized treatment of CRC.     

Comparison of different methods to estimate BMR in adoloscent student population

There is a growing clinical emphasis for the measurement of BMR and energy expenditure in clinical and research investigation such as obesity, exercise, cancer, under-nutrition, trauma and infections. Hence, there is a motivation towards calculating basal metabolic rate using standard equations. The objective of the present work is to identify an appropriate equation in Indian environment for the estimation of calorie needs and basal metabolic rate using the measured height, weight, age and skin fold parameters of an individual. Basal metabolic rates of adolescent male and female population aged between 17-20 years were estimated using equations proposed by FAO, ICMR, Cunningham, Harris Benedict, Fredrix and Miffin. Calorie needs were calculated using factorial approach which involves the multiplication of basal metabolic rate with appropriate physical activity factor. Basal metabolic rates estimated by FAO, Cunningham, Harris-Benedict, Fredrix and Miffin are reduced by 5%. These reduced basal metabolic rates and calorie needs are compared with that obtained by Cunningham's equation which is considered as accurate equation. Comparison of the basal metabolic rates and calorie needs obtained by Cunningham equation with all equations such as Harris-Benedict, FAO, Fredrix and Miffin after 5% reduction and ICMR equation without reduction indicates that Harris-Benedict, Fredrix, Miffin and FAO equations can be used for male and female adolescent populations for Indian environment. In conclusion, Harris-Benedict equation is an appropriate equation for both male and female adolescent population for Indian environment.     

Microwave-mediated synthesis of triazolothiadiazoles as anti-inflammatory,analgesic, and anti-oxidant agents

Efficient approach to the synthesis of a series of triazolothiadiazole analogs of ibuprofen has been carried out using microwave energy. Thus a series of 1,2,4-triazolo[3,4-b]-thiadiazoles 5 were synthesized starting from 4-amino-3-[1-(4-isobutylphenyl)ethyl]-5-mercapto-1,2,4-triazole 3 and different aromatic acids using phosphorous oxychloride as cyclizing agent by microwave and conventional method. Microwave irradiation reduces both time and reaction endeavors along with reduced amount of phosphorous oxychloride. In addition, preliminary results of the biological evaluation of these compounds are also reported and they found to exhibit significant antioxidant, anti-inflammatory, and analgesic activities with reduced ulcerogenicity.     

Clinical significance of normal chest radiographs among HIV-seropositive patients with suspected tuberculosis in Uganda

Background and objective: The frequency, aetiologies and outcomes of normal chest radiographs (CXRs) among HIV‐seropositive patients with suspected pulmonary tuberculosis (TB) have been infrequently described. Methods: Consecutive HIV‐seropositive adults hospitalized for cough of ≥2 weeks duration at Mulago Hospital (Kampala, Uganda), between September 2007 and July 2008, were enrolled. Baseline CXRs were obtained on admission. Patients with sputum smears that were negative for acid‐fast bacilli (AFB) were referred for bronchoscopy with bronchoalveolar lavage (BAL). BAL fluid was examined for mycobacteria, Pneumocystis jirovecii and other fungi. Patients were followed for 2 months after enrolment. Results: Of the 334 patients, 54 (16%) had normal CXRs. These patients were younger (median age 30 vs 34 years, P = 0.002), had lower counts of CD4+ T lymphocytes (median 13 vs 57 cells/µL, P < 0.001), and were less likely to be smear positive for AFB (17% vs 39%, P = 0.002) than those with abnormal CXRs. Pulmonary TB was the most frequent diagnosis (44%) among those with normal CXRs, followed by unknown diagnoses, pulmonary aspergillosis and pulmonary cryptococcosis. The frequency of normal CXRs was 12% among pulmonary TB patients. There was a trend towards increased 2‐month mortality among patients with normal CXRs compared to those with abnormal CXRs (40% vs 29%, P = 0.15). Conclusions: Normal CXR findings were common among HIV‐seropositive patients with suspected TB, especially those who were young, those with low CD4+ T cell counts and those with sputum smears that were negative for AFB. Mortality was high among those with normal CXRs. Normal CXR findings should not preclude further diagnostic evaluation in this population.