European Journal of Cardiovascular Medicine

Background: Aluminium phosphide (ALP) poisoning is a significant cause of morbidity and mortality in developing countries due to its widespread use as an agricultural fumigant and lack of a specific antidote. The toxicity of phosphine gas released after ingestion primarily affects the cardiovascular system, leading to myocardial depression, refractory hypotension, and life-threatening arrhythmias. Advanced supportive measures such as extracorporeal membrane oxygenation (ECMO) have recently been used in severe cases with cardiogenic shock. This study aimed to evaluate the cardiovascular manifestations, clinical outcomes, and the role of ECMO in patients with aluminium phosphide poisoning. Methods: This prospective observational study was conducted in the Department of Medicine and Intensive Care Unit at Geetanjali Medical College and Hospital (GMCH), Udaipur, over a period of six months. A total of 50 patients with confirmed aluminium phosphide poisoning were included. Demographic characteristics, hemodynamic parameters, electrocardiographic findings, echocardiographic assessment, arterial blood gas analysis, laboratory investigations, and treatment modalities including ECMO were recorded. Left ventricular ejection fraction (LVEF) was assessed at admission and discharge. Patients were followed during hospitalization to determine clinical outcomes. Results: The mean age of patients was 33.39 ± 11.72 years with a slight male predominance. The overall mortality rate was 36%. Patients commonly presented with hypotension and tachycardia. Significant myocardial depression was observed at admission with markedly reduced LVEF, which improved significantly at discharge among survivors. Ventricular tachycardia and ventricular fibrillation were the most common arrhythmias. Significant differences in arterial blood gas parameters, including pH, PaCO₂, PaO₂, and lactate levels, were observed between survivors and non-survivors. Laboratory parameters demonstrated significant changes in lactate, hemoglobin, liver enzymes, and electrolytes during hospitalization. ECMO support was required in patients with severe cardiogenic shock and refractory circulatory failure. Conclusion: Cardiovascular dysfunction is a major determinant of outcome in aluminium phosphide poisoning. Early recognition of myocardial depression, metabolic abnormalities, and arrhythmias, along with advanced supportive therapies such as ECMO in selected patients, may improve survival in severe cases.

Background: Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus and is a major cause of lower limb amputation worldwide. Accurate risk stratification is essential to guide management and improve limb salvage. The Society for Vascular Surgery Wound–Ischemia–Foot Infection (SVS-WIfI) classification system was developed to assess the severity of limb threat and predict the risk of amputation in patients with diabetic foot disease. Aim of the study was to evaluate the effectiveness of the SVS-WIfI scoring system in predicting the risk of amputation in patients with diabetic foot ulcers and to analyze the association between individual components of the WIfI score and clinical outcomes. Material and Methods: This prospective observational study included 70 patients with diabetic foot ulcers attending the Department of General Surgery between January 2024 to January 2026 2024. Patients were staged using the SVS-WIfI classification system and grouped as Group 1 (WIfI stages 1–3) and Group 2 (WIfI stage 4). Patients were followed for six months to record outcomes, with amputation (minor or major) considered the primary outcome. Associations between WIfI components and amputation risk were analyzed using contingency tables, and sensitivity and specificity of the WIfI system were calculated. Results: Among the 70 patients, 20 (28.6%) belonged to Group 1 and 50 (71.4%) belonged to Group 2. Overall, 49 patients (70%) underwent amputation, including 28 minor and 21 major amputations. Amputation rates were significantly higher in Group 2 (84%) compared to Group 1 (35%). Increasing severity of wound grade, ischemia, and infection was associated with higher amputation rates. The WIfI system showed 85.7% sensitivity and 61.9% specificity for predicting overall amputation and 95% sensitivity for predicting major amputation. Conclusion: The SVS-WIfI classification system is a useful clinical tool for risk stratification in diabetic foot ulcers. Higher WIfI stages are strongly associated with increased risk of amputation, emphasizing the importance of early staging and timely intervention to improve limb salvage outcomes.

Background: Globally, acute respiratory infections (ARI) are the leading cause of death among children under five with pneumonia alone being responsible for 18% of deaths.  On average an under five child suffers from 6-8 episodes of ARI per year. Around 2 million children under five dies from the disease every year – around one in every five children globally. India has the largest number of pneumonia deaths. Most of these ARI deaths are due to risk factors that are modifiable and mothers of children under five have limited knowledge of ARI and its modifiable risk factors, which can be prevented by health education or treated with simple, affordable interventions.  Objectives: To assess the knowledge and practices among mothers of under five children regarding prevention and control of ARI in rural field practice area of VIMS & RC at Mallasandra PHC. To provide Information, Education and Communication (IEC) to the above mothers of under five children regarding prevention and control of ARI. To assess the effectiveness of IEC on these mothers every quarterly during 6 months period of post intervention. Methodology: An Interventional study was conducted in villages in Mallasandra Primary Health Centre area which is the field practice area of VIMS&RC Bengaluru. Stratified random sampling method was used to collect data from mothers of under five children regarding ARI. House to house visits were made to collect required information. A semi structured pre designed questionnaire was used. Clinical assessment and anthropometry were used to assess the knowledge and practices among mothers of under five children regarding prevention and control of ARI. Results: During the initial assessment, 55% of the mothers had good knowledge and practice levels and 45% had poor knowledge and practice levels. After intervention percent of mothers having good knowledge and practice levels increased to 60% of the mothers and 64% of the mothers during the first quarterly assessment and second quarterly assessment. The factors with highly significant association with ARI were lack of exclusive breast feeding for 6 months (p < 0.0001), weaning (p < 0.0001), inappropriate fuel used in home (p < 0.0001) and inadequate ventilation in home (p < 0.0001).Malnutrition (p = 0.0116), anaemia (p = 0.007), poor hygienic practices (p = 0.0063), improper home management (p = 0.0174) and type of health service utilized (p = 0.0108) were also significant. Conclusions: Deficit of knowledge and practices regarding acute respiratory tract infections existed in varying degrees in the mothers of under-five children. The IEC were effective in imparting the knowledge and improving of practices of the mothers of under-five children in management of acute respiratory tract infections.

Background: Although institutional deliveries have increased under national maternal health programmes, postnatal care service utilization continues to be insufficient in urban India. The present study aimed to evaluate the utilization of postnatal maternal health care services among urban women. Aims: To assess various determinants related to maternal health care services utilization and assess the utilization status of healthcare services during the postnatal care period Methodology: This was a community-based cross-sectional study conducted in urban areas of the Saurashtra region of Gujarat. Probability proportional to size (PPS) sampling followed by systematic random sampling was used in urban area of saurashtra region, Gujarat. A total of 508 women in the reproductive age group, who had delivered a child aged 42 days to 6 months and had resided in the study area for at least six months, were included in the study. Results: Among 508 mothers, most were aged 23–32 years and had primary education. The majority delivered in government facilities, mainly by vaginal delivery. Postnatal care utilization was suboptimal, with low contraceptive use. While most received IFA, calcium, and counselling services, maternal education was significantly associated with reproductive practices, micronutrient intake, and awareness of maternity schemes (p < 0.001). Conclusions/ key message: Maternal education strongly influences postnatal care utilization, reproductive health practices, and awareness of maternal health schemes, highlighting the need to improve education and counselling to enhance service uptake.

Background: Spinal anaesthesia (SA) is a standard technique for caesarean sections, but it commonly induces hypotension, which is defined as a systolic blood pressure (SBP) drop of over 20% from baseline or an SBP below 90 mmHg. This hypotension, resulting from venous pooling due to sympathetic blockade and progesterone-induced vascular tone reduction, is observed in 80-83% of cases and poses risks to both mother and fetus. Effective management strategies include intravenous fluid preload and sequential compression devices (SCDs), yet comparative data on their efficacy remain sparse. This study aims at comparing the effectiveness of Sequential Compression Devices (SCDs) versus Crystalloid Preload in reducing post-spinal hypotension during caesarean sections. Aim: To determine and compare the effectiveness of sequential compression devices and crystalloid preloading in reducing incidence of hypotension after spinal anaesthesia in elective caesarean section. Materials and Methods: A randomized controlled study was conducted on 60 patients undergoing elective caesarean sections. Patients were randomised to the Crystalloid group (n = 30) or the SCD group (n = 30). Group C received a Ringer Lactate preload (10 ml/kg over 10 minutes), while Group S used SCDs (compression at 60 mmHg) prior to spinal block. Parameters monitored included heart rate, systolic and diastolic blood pressure, and the need for additional treatments. Data were analyzed using SPSS v23.0, with a p-value <0.05 deemed statistically significant. Results: The mean age of participants was 26.8 ± 3.5 years, with nil significant age differences between the groups. Heart rate changes also showed no differences between the two groups. Systolic blood pressure (SBP) dropped significantly from the 6th to 12th minute in the Crystalloid group compared to the SCD group (p < 0.05). Diastolic blood pressure (DBP) was significantly lower in the SCD group at the 55th and 60th minutes post-intervention (p < 0.05). The Crystalloid group required significantly more additional treatments at the 6th minute (p < 0.05). Conclusion: Sequential Compression Devices (SCDs) are more effective than Crystalloid Preload in mitigating early post-spinal hypotension during caesarean sections. SCDs provide superior stability of systolic blood pressure and reduce the need for additional treatments shortly after anaesthesia administration, making them a preferable option in managing post-spinal hypotension in caesarean sections.

Objective: Dyslipidemia prevalence in India has significantly increased over the past three decades, posing a modifiable risk factor for cardiovascular diseases. Although statins remain the most effective treatment option, many patients report partial or total statin intolerance (SI). Bempedoic acid has emerged as a potent alternative for lowering low-density lipoprotein cholesterol (LDL-C) levels in patients with atherosclerotic cardiovascular disease (ASCVD).  Methodology: From May to August 2023, six advisory board meetings were held in India, focusing on managing dyslipidemia with bempedoic acid and other therapies. A literature search across MEDLINE, EMBASE, and Cochrane-indexed databases guided these discussions.  Results: Experts recommended switching to non-statin drugs for partial SI, reducing statin doses for patients intolerant to high-intensity statins, and considering bempedoic acid for patients with SI or contraindications. Early use of combination therapies, such as ezetimibe with high-intensity statins, was also advised to help high-risk patients achieve LDL-C goals more quickly. The findings highlight evolving clinical practice in India, where growing awareness of SI and the availability of new agents like bempedoic acid are shaping personalized treatment strategies. There was strong support for leveraging real-world evidence and expert consensus to inform broader clinical adoption of non-statin and combination therapies.  Conclusion: Expert insights from nationwide advisory board meetings highlight the need to individualize dyslipidemia management, especially in patients with SI. Bempedoic acid, along with other non-statin options and early combination strategies, offers promising avenues for optimizing LDL-C control in high-risk Indian patients.

Background: The axillary arch (Langer’s arch) is a known anatomical variation with important clinical implications due to its relationship with axillary neurovascular structures. Methods: A descriptive cadaveric study was conducted on 25 formalin-embalmed cadavers (50 axillae). Standard dissection procedures were followed to identify the presence, morphology, and attachments of the axillary arch. Results: The axillary arch was identified in one cadaver (4%) and was bilateral (2% of axillae). It exhibited a fibromuscular morphology and extended from the latissimus dorsi to the coracobrachialis muscle, representing a complete type. Conclusion: This study reports a rare combination of bilateral occurrence, fibromuscular nature, and atypical insertion of the axillary arch. Awareness of such variations is essential to avoid surgical complications.

Background: The choice of anesthetic induction agent is particularly critical in patients with pre existing cardiac disease undergoing non cardiac surgery. Etomidate and propofol are commonly employed agents, yet they exert distinct cardiovascular effects. This study retrospectively evaluates the hemodynamic responses associated with etomidate versus propofol induction in cardiac patients undergoing non cardiac procedures. Materials and Methods: A retrospective observational analysis was conducted on 150 patients with documented cardiac comorbidities who underwent non cardiac surgery. Patients had received either etomidate (0.3 mg/kg) or propofol (2 mg/kg) for induction, as per anesthesiologist preference. Hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and cardiac output (CO) were extracted from anesthesia records at baseline, immediately post induction, and at one, three-, and five-minutes following induction. Data were analysed using SPSS version 25, with statistical significance defined at p < 0.05. Results: Patients induced with etomidate demonstrated only a modest decline in systolic blood pressure (baseline 130 ± 10 mmHg vs. post induction 126 ± 9 mmHg, p = 0.09), whereas those receiving propofol exhibited a marked reduction (baseline 132 ± 9 mmHg vs. post induction 111 ± 8 mmHg, p < 0.001). Heart rate remained stable in the etomidate group (baseline 75 ± 6 bpm vs. post induction 76 ± 5 bpm, p = 0.11), while propofol recipients showed a significant increase (baseline 74 ± 7 bpm vs. post induction 87 ± 6 bpm, p < 0.001). Cardiac output values were consistently better preserved in the etomidate group compared to the propofol group. Conclusion: This retrospective analysis suggests that etomidate provides superior cardiovascular stability compared to propofol in patients with cardiac disease undergoing non cardiac surgery. The pronounced hypotension and compensatory tachycardia observed with propofol warrant caution in this high risk population. Etomidate may thus represent a safer induction choice for maintaining perioperative hemodynamic stability.

Background: Spinal anaesthesia-induced hypotension occurs in 70-80% of parturients undergoing cesarean delivery. This study compared the predictive accuracy of tricuspid annular plane systolic excursion (TAPSE) versus carotid flow time with passive leg raising (CFT-PLR) for identifying patients at risk of hypotension. Methods: This prospective observational study conducted at Sri Devaraj Urs Medical College enrolled 30 parturients undergoing elective cesarean delivery under spinal anaesthesia, randomly allocated into TAPSE (n=15) and CFT-PLR (n=15) groups. Hypotension was defined as mean arterial pressure decrease >25% from baseline. Receiver operating characteristic curves evaluated predictive accuracy. Results: Hypotension occurred in 73.3% (TAPSE) and 66.7% (CFT-PLR) of patients. TAPSE ≤18.5 mm predicted hypotension with 81.8% sensitivity, 75.0% specificity, and AUC 0.848. ΔCFT ≤12 ms showed 80.0% sensitivity, 80.0% specificity, and AUC 0.870 (p=0.762 between methods). TAPSE measurements were faster (3.1 vs. 5.4 minutes, p<0.001). Strong correlations were observed between both parameters and hemodynamic outcomes (r>0.70, p<0.001). No adverse neonatal outcomes occurred. Conclusion: Both TAPSE and CFT-PLR effectively predict spinal anaesthesia-induced hypotension with comparable accuracy. TAPSE offers faster assessment, while CFT-PLR provides dynamic preload evaluation. Both methods are clinically feasible for personalized prophylactic interventions.

COVID 19 has affected everyone around the globe equally. The effects were not only confined to respiratory system, rather it affected all the systems, specially the ones which have high expression of ACE2 or TMPRSS2. The most affected organs for COVID-19 infection are Respiratory, Cardiovascular, GIT and Reproductive systems. There have been reports of women complaining of menstrual irregularities happening after COVID infection as well as Vaccine. But all the reports were confined to initial few months of COVID Infection/Vaccination. We conducted an online survey enquiring the effects of COVID infection on Menstrual Cycle of Reproductive age Women. The data was collected from May 2023 to April 2024. We found that Women complaining of changes in the Menstrual cycle almost doubled i.e. 20.4% (11.1% previously) after suffering from COVID Infection/Illness. 12% women reported an abnormal passage of clots (which never happened earlier) after the COVID 19 infection. 20% women reported a more permanent change (change for more than 3 months) in the cycle length after the infection. Our study indicates that women has suffered serious changes in their menstrual cycle which has negatively affected their overall wellbeing. Though we have not addressed the problems in conception and pregnancy related complications due to COVID infection but they must be severely affected as well. So the changes in menstrual cycle and pregnancy related complications must be further investigated in a bigger population having wide coverage over different socio-economic and demographic areas.

Background: The optimal treatment strategy for in‑stent restenosis (ISR) still remains under debate. There have been scarce data on Indian patients relating to ISR treatment. Hence the present study was undertaken to study the clinical profile and angiographic patterns of patients admitted with ISR and they were followed for 6 months for outcomes associated with different treatment modalities.  Method: A total of 200 patients were enrolled in study during a period from January 2022 to March 2023. All patients underwent a general and cardiac evaluation. We evaluated the types of clinical presentation, and angiographic characteristics of ISR, laboratory parameters, treatment modalities used for stenting ISR lesions and the outcomes that occurred within a minimum period of 6 months from the date of the clinical presentation. Results: Unstable angina (39.5%) and NSTEMI (36%) were the common clinical presentations noted for ISR cases. Single vessel disease (46%) with LAD involvement (60%) was common amongst ISR cases, with uncontrolled DM (90%) being a commonly noted factor. Non-focal ISR (65%) with involvement of previous DES and BMS stent usage was seen amongst patients. Most patients with previous BMS stent had neo-atherosclerosis (56.25%) while for previous DES cases, the commonest IVUS finding was under expansion (53.84%). Commonest treatment modality adopted for ISR cases was PTCA (64%), which led to significant increase in both, stent length and stent diameter after management. The overall outcomes of ISR management were promising, with 97.5% cases discharged from hospital after management and maintaining well at 6-month follow up as well.  Conclusion: This study highlights the effectiveness of current ISR management strategies and underscores the need for ongoing monitoring and tailored treatment approaches in the Indian population.

Background: Acute pharyngitis is a common cause of upper respiratory tract infection in children, which is highly contagious. In most cases, pharyngitis is caused by Streptococcus pyogenes, which can lead to severe invasive diseases, including rheumatic heart disease and Acute glomerulonephritis. Aim: To determine the Prevalence and Antibiotic susceptibility pattern of Streptococcus pyogenes (GABHS- Group A β-Hemolytic Streptococci) causing acute pharyngitis in children. Settings and Design: A Prospective observational study was conducted in the Department of Microbiology and Paediatrics over 6 months (April 2025 – September 2025). Materials And Methods: A total of 147 throat swabs were collected from children aged 3-12 years with symptoms of acute pharyngitis. Bacterial culture was performed on Columbia blood agar, and Streptococcus pyogenes was identified according to standard guidelines. Antibiograms were obtained by the Kirby-Bauer disc diffusion method. Results: The prevalence of GABHS was about 42 (28.6%) among 147 patients. Out of 42 patients, 22(52.3%) children were in the age group of 5-10 years. Organisms like Staphylococcus aureus 11 (7.4%), Streptococcus pneumoniae and other beta-hemolytic Streptococci 36(24.5%) were also isolated. Penicillin (96%), Vancomycin (94%), Ceftriaxone (90%), and Erythromycin (86%) are highly susceptible, whereas clindamycin (88%) and chloramphenicol (85%) are moderately susceptible.  Azithromycin, Tetracycline, and levofloxacin were the least susceptible. Conclusion: In this study population, Streptococcus pyogenes was isolated in about 28.5% from acute pharyngitis patients. Children aged 5 to 10 years were more susceptible to Streptococcus pyogenes. Almost all antibiotics were susceptible to GABHS except Levofloxacin and Tetracycline. Therefore, screening of GABHS before prescribing antibiotics is necessary.

Acute Type B aortic dissection (A. Type B AD) is a vascular emergency that may present atypically, delaying diagnosis. A 49-year-old man having poorly controlled hypertension presented with acute epigastric pain radiating to the left chest, without classic tearing epigastric pain radiating to left chest and back. Initial ECG was normal, only with mild troponin elevation on labs. CT aortography revealed a simple A. Type B AD confined to the descending thoracic aorta, without rupture or malperfusion. The patient was managed uilizing aggressive medical therapy, including IV β-blockade and strict BP control, and promptly referred to a tertiary vascular center. This case highlights the diagnostic challenge of atypical pain and the importance of early CT imaging and guideline-directed medical management to improve outcomes.

Background: Introduction: Variations in the morphological anatomy of the median nerve in formation, course, distribution and communications have been verified. Anatomical variations of median nerve are clinically important, when practicing surgical approach for treatment of injuries affecting median nerve. Material and methods: While dissecting among cadavers, observed variations in the formation of median nerve by three roots with the absence of musculocutaneous nerve supplying the muscles of front of arm by giving a branch after formation of trunk & a communicating branch between median nerve and musculocutaneous nerve. Conclusion: Empathy – Focused in these variations is crucial because they may affect the function of the upper limb. For clinicians, it is important to remember these variations during surgical procedures in this area and during brachial plexus block.