Recent advances in diagnosis and management of pulmonary hypertension in chronic lung disease

Pulmonary hypertension with elevated pulmonary vascular resistance is a common cardiovascular complication associated with increased morbidity and mortality in preterm infants with chronic lung disease. Injury to the developing pulmonary circulation results in structural and functional abnormalities of the pulmonary vasculature. Animal studies have demonstrated that disruption of angiogenesis may contribute to the failure of normal alveolarisation in chronic lung disease. Levels of vascular endothelial growth factor in bronchoalveolar lavage fluid are lower in infants with chronic lung disease compared to preterm controls. Supplemental oxygen is commonly used to prevent and treat pulmonary hypertension, although optimal arterial oxygen saturation levels remain uncertain. Other vasodilators such as inhaled nitric oxide appear promising, but as yet have not been evaluated in the form of randomised controlled trials. Further studies are required to investigate the long-term effectiveness of pulmonary vasodilator therapy.     

Predictors of acceptance and willingness to pay for the COVID-19 vaccine in the general public of India: A health belief model approach

Objective:To determine the predictors of acceptance and willingness to pay(WTP)for the COVID-19 vaccine among the Indian public and to provide insights for future demand forecasts and pricing considerations.Methods:A nationwide,web-based,self-administered,crosssectional survey was conducted from 5 to 20 October 2020.The health belief model(HBM)approach was used as a theoretical framework to assess the predictors of acceptance of and WTP for the COVID-19 vaccine.Results:Of 2480 respondents,2451 completed the online survey,yielding a response rate of 98.8%.Participants who participated in the survey had diverse demographics in terms of their location,educational level,occupation type,and family income.Among 2451 respondents,the majority(89.3%)intended to receive the COVID-19 vaccine.Respondents with high perceived benefits of COVID-19 vaccination,such as reduction in worry(OR 5.87;95%CI 4.39-7.96)and sickness(OR 4.31;95%CI 3.31-5.62),showed higher intention to receive the vaccine.However,respondents with a high perception of the side effects and barriers to vaccination(OR 0.36;95%CI 0.25-0.54)and vaccine shortage(OR 0.58;95%CI 0.41-0.81)showed lower intention to receive the vaccine.The majority(2162,88.21%)of respondents were willing to pay an amount of INR:500-1000 or USD:6.81-13.62 for a dose of COVID-19 vaccine,with a median(Q1,Q3)of INR:500(500,1000)or USD:6.81(6.81,13.62).The higher marginal WTP for the COVID-19 vaccine was influenced by advanced age,marital status,female sex,intermediate educational background,high family income,fair or poor perceived health status,and no affordable barriers.Conclusions:The majority of respondents intended to receive the COVID-19 vaccine.Healthcare interventions focusing on HBM constructs and demographic predictors associated with low intention to receive the vaccine can be effective in enhancing the coverage of the COVID-19 vaccine.The findings of this study provide guidance for the future price considerations of the COVID-19 vaccine.     

杂交技术在法洛四联症中的应用

目的:总结杂交技术镶嵌治疗儿童法洛四联症(TOF)的经验。方法:外科术前介入治疗:3例有巨大体肺侧支(APCAs)的重症TOF在根治术前予以侧支血管堵塞术。外科术后镶嵌治疗:6例TOF根治术后残余分流,其中4例残余膜周部室间隔缺损,1例残余左室右房通道室间隔缺损,1例残余房间隔缺损,分别予以经导管残余心脏缺损封堵术。结果:3例有巨大APCAs的重症TOF在根治术前予以侧支血管堵塞术后随即进行外科手术,皆获得满意效果。6例TOF根治术后残余分流者行经导管封堵术封堵成功,随访无残余分流及心脏瓣膜异常,未出现心律失常。结论:杂交技术镶嵌治疗伴有巨大APCAs及术后存在残余分流的TOF安全、有效。     

Education is associated with reduction in racial disparities in kidney transplant outcome

In this study, we hypothesized that higher level of education might be associated with reduced racial disparities in renal transplantation outcomes. We used data from the United States Renal Data System (September 1, 1990–September 1, 2007) (n = 79 223) and analyzed two outcomes, graft loss and recipient mortality, using Cox models. Compared with whites, African Americans had increased risk of graft failure (HR, 1.48; p < 0.001) and recipient mortality (HR, 1.06; p = 0.004). Compared with recipients who graduated from college, all other education groups had inferior graft survival. Specifically, compared with college‐graduated individuals, African Americans who never finished high school had the highest risk of graft failure (HR, 1.45; p < 0.001), followed by high school graduates (HR, 1.27; p < 0.001) and those with some college education (HR, 1.18; p < 0.001). A similar trend was observed in whites. In African Americans (compared with whites), the highest risk of graft failure was associated with individuals who did not complete high school (HR, 1.96; p < 0.001) followed by high school graduates (HR, 1.47; p < 0.001), individuals with some college education (HR, 1.45; p < 0.001), and college graduates (HR, 1.39; p < 0.001). A similar trend was observed with recipient mortality. In sum, higher education was associated with reduced racial disparities in graft and recipient survival.     

Trigeminal Neuralgia in Pregnancy: A Management Challenge

Pregnancy is known to aggravate pre‐existing chronic painful conditions. Trigeminal neuralgia (TN), albeit a disease of the elderly, may afflict pregnant females, which can further complicate its management. Teratogenic effects of the commonly used drugs on the developing fetus limit pharmacological treatment. Moreover, safety of commonly performed interventional therapies is marred by their inherent fetomaternal effects and more importantly the risk for radiation effects on the fetus due to the use of fluoroscopy. This rare coexistence of TN in pregnancy has not been reported before. Here we present a case of TN in a young woman, whose pain was aggravated when she became pregnant, and she was treated successfully by conventional radiofrequency ablation of the Gasserian ganglion.     

Relationship of Quality of Life with Disability Grade in Obsessive Compulsive Disorder and Dysthymic Disorder

Background:

There is paucity of information on the relationship of quality of life (QOL) in obsessive compulsive disorder (OCD) and dysthymic disorder (DD) with disability grade in India.

Aim:

To assess the relation of QOL with disability level in OCD and DD.

Materials and Methods:

This hospital based study was conducted in a medical institution in Davanagere, Karnataka, India. Data was collected by using Diagnostic and Statistical Manual IV Text Revision (DSM IV TR) criteria, WHO QOL BREF and IDEAS. Relationship between disability grade and QOL was assessed by independent sample t test.

Results:

Mild disabled OCD patients had a significantly better QOL in the Q1 domain i.e. perception on quality of life as compared to moderately disabled patients (P < 0.05), while in other domains of QOL, there was no statistically significant difference (P > 0.05). But, QOL score in physical domain showed significant difference across disability grades (56.00, SD = 6.89; 48.50, SD = 12.28) in DD, but not in other domains.

Conclusion:

Perception of QOL is better in those with mild disability in OCD, but in DD, physical domain of QOL score is more in mild disability compared to moderate disability.