Fortis Malar Hospital

Abstract Background Kinesiophobia (fear of movement) is prevalent after a myocardial infarction and in atrial fibrillation (prevalence 20% and 70%, respectively) and may impede the ability to be physically active as recommended in guidelines. Purpose To evaluate the feasibility of an 8-week digital program (MOVE-IT) regarding changes in kinesiophobia, cardiac anxiety, self-rated health, and to explore patient´s experiences of the program. Methods The MOVE-IT program, based on problem-based learning and cognitive behavioural therapy, was digitally delivered to base-groups supervised by a nurse or physiotherapist. The primary outcome was a change in kinesiophobia, i.e., score of ≥ 37 using the Tampa Scale of Kinesiophobia Swedish Version for the Heart (TSK-SV Heart). Changes in scores on the Cardiac Anxiety Questionnaire (CAQ) and the EuroQol-VAS (EQ-VAS) were also assessed. Individual semi-structured interviews were analysed by conventional qualitative content analysis. Preliminary results: Nine participants, mean age 73 years, 78% female, 89% atrial fibrillation and 11% myocardial infarction. The majority of the participants engaged in physical activity (> 30 minutes) on two days or fewer per week. At baseline, the mean score of TSK-SV Heart was 43.6 (SD 4.4), and 8-weeks (end of program), and 3-month follow-up, the mean scores were 34.8 (SD 3.5) and 25.9 (SD 4.0), respectively. This represents a reduction of 8.8 points (20%) by the end of the study and a reduction of 17.7 points (26%) at the 3-month follow-up compared to baseline. For CAQ, the mean values at baseline, 8-weeks, and follow-up, were 37.4 (SD 9.4), 25.2 (SD 5.2), and 19.8 (SD 5.7), respectively. This corresponds to reductions of 11.9 points (32%) and 17.6 points (47%) at the 8-weeks and 3-month follow-up, respectively. At baseline, the mean value on EQ-VAS was 60.9 (SD 18). At 8 weeks, the score had increased by 11.1 points to 72 (SD 20.6), and at 3 months, it had risen by 17.4 points to 78.3 (SD 13.6). Compared to baseline, this represents an increase of 18% and 28%, respectively. At 8 weeks, none of the participants’ scores decreased, and the change in scores varied from 0 to 20 points (0% to 67%). The qualitative findings showed an initially restrictive existential fear for death concerning physical activity. However, the base-group’s authentic and genuine support was existentially comforting. The tutor was confident, guiding and supportive in an invaluable way. The program felt challenging and strengthening despite initial digital obstacles. The kinesiophobia was relieved or gone. This promoted the participants to be physically active and to plan future goals. Conclusions The MOVE-IT program indicates promising results in a small group of participants, showing a considerable decrease in kinesiophobia and cardiac anxiety, as well as improved self-rated health after the program and three months later. More participants will be enrolled in this pilot study for it to be completed.

Abstract: In our day-after-day life traveling has become one of the necessary aspects of a person’s being. usually for traveling purpose individuals uses normal traditional bags or luggage however in today’s world such sort of bag doesn’t seem to be safe for the security purpose of reading. With the speedy advancement of technology within smartphones, laptops, and many similar devices, our dependency on them has drastically become hyperbolic. Traveling persons are facing several safety issues for luggage today. Thus, they feel unfit in such cases and want facilities to shield themselves. All electronic inventions aim to reduce the manual effort required for mechanical tasks and establish a seamless interaction between humans and machines. Here we tend to introduce a device that ensures the protection of baggage in a bag. The micro-controller, which is the brain of the system, will manage all the distinctive features of the projected system. Additionally, the solar panel located on the front part of the bag can be used to charge electronic devices such as mobile phones, laptops, and power banks. RFID automation is automated to solve the forgetting fullness to pack the desired things. A bag tracking system can inform you wherever your bag is and wherever it’s been, however long it has been. Ultrasonic sensors area unit accustomed to creating a human following system to create a bag that follows its owner. The system uses geographic position and time data from the GPS Module which can track the bag employing a Mobile application. During this bag at intervals a little platform, all the facilities area unit enforced along expeditiously. So, the Smart bag is associated application-specific specific type that may be helpful for pretty much everybody in society

Funding AcknowledgementsType of funding sources: None.BackgroundHome-based cardiovascular disease (CVD) primary prevention (HBPP) and cardiac rehabilitation (HBCR) programs which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic.PurposeThis study aims to analyse the effectiveness of a home-based CVD prevention program implemented during the pandemic in India.MethodsA retrospective study was conducted on pre-pandemic and pandemic enrolees. Health behaviour, CVD risk factors, physical and mental component score (PCS, MCS) from SF-12 questionnaire, body mass index (BMI), 6-minute walk distance (6MWD), and clinical and biochemical parameters were assessed. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician and Counselling Psychologist provided the program using tele-health platforms.ResultsOf the 66 subjects (55 ± 13 years, 73% male), 17 (26%) enrolled pre-pandemic and 49 (74%) enrolled during-pandemic, 28 (42%) were HBPP and 38 (58%) were HBCR participants. Majority of the subjects (n = 51, 77%), with significantly more HBCR than HBPP participants, harboured 4 or more risk factors (p = 0.04). In the 60 (91%) program completers, BMI, 6MWD, PCS and MCS had improved significantly. SBP, DBP, LVEF, HbA1c, total cholesterol and LDL had improved significantly in affected subjects. Completely home-based participants (n = 44, 67%) who never had any in-person contact with the team during the program also showed significant improvement. No adverse events were reported.ConclusionComprehensive home-based CVD prevention programs are effective in improving anthropometric, clinical, biochemical and psychosocial parameters, are a safe alternative to conventional programs and could potentially become the standard-of-care in the post-pandemic era. Figure. Outcomes in program participants Figure. Management of ACS in participants

Background: Seizures are one of the common causes of hospitalization in children causing significant morbidity and mortality. Objective: The objective of the study was to study the clinico-etiological profile of children admitted with seizures. Materials and Methods: This cross-sectional study included 120 children admitted with seizures to the pediatric ward and pediatric intensive care unit of a teaching hospital over a period of 12 months. Clinically relevant history, demographic data, and laboratory investigations were obtained. Electroencephalogram (EEG) and magnetic resonance imaging (MRI) were done based on the clinical situation. Results: The sex-wise distribution of children showed an overall male predominance (male:female=1.3:1). The occurrence of convulsions was highest (60%) in the age group of 1–5 years. The majority of children had (81.7%) generalized tonic-clonic seizures. Febrile seizures (46.7%) were found to be the most common cause of seizures in children. This was followed by a seizure disorder in 19.2% and cerebral palsy in 15% of them. Conclusion: The etiology of seizures was identified in almost 94% of the cases through a detailed history, physical examination, laboratory workup, and with EEG and MRI studies as indicated. Thus, a thorough evaluation is recommended in every child presenting with seizures to understand the clinico-demographic profile and the etiology of seizures in children.

Bell facial paralysis association with pregnancy pathology is quite rare in practice, but reported to the cases outside gestation it is 2 times more frequent, which was why we decided to present this case. In the presented case, we note that the neurological pathology was revealed in a patient, aged 34 years and located in 34 weeks gestation with pregnancy-induced hypertension which was presented accusing facial asymmetry insidiously installed. The treatment was agreed between the obstetrician and the neurologist. Birth was conducted in normal dynamic parameters, evolving naturally with a good fetal and maternal prognosis. Further development of the peripheral facial paralysis was slowly favorable, with a partial remission 3 weeks later. A year and a half after this episode that took place during the gestation, the neurological and clinical examination revealed the persistence of a discrete facial asymmetries.

BackgroundThe comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors.MethodsIn this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up.ResultsA total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76).ConclusionsAmong patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart–Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10; ClinicalTrials.gov number, NCT02311231.)

No reliable comparative data exist between open repair (OR) and endovascular aneurysm repair (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR and EVAR for MAAA in a population-based cohort. All patients treated for MAAAs in Sweden between 1994 and 2014 were identified in the Swedish vascular registry. The primary aim was to assess survival after MAAA with OR and EVAR. Secondary aims were analyses of the rate of recurrent infections and reoperations, and time trends in surgical treatment. Survival was analyzed using Kaplan-Meier and log-rank tests. A propensity score-weighted correction for risk factor differences in the 2 groups was performed, including the operation year to account for differences in treatment and outcomes over time. We identified 132 patients (0.6% of all operated abdominal aortic aneurysms in Sweden). Mean age was 70 years (standard deviation, 9.2), and 50 presented with rupture. Survival at 3 months was 86% (95% confidence interval, 80%-92%), at 1 year 79% (72%-86%), and at 5 years 59% (50%-68%). The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994-2000 0%, 2001-2007 58%, 2008-2014 60%). Open repair was performed in 62 patients (47%): aortic resection and extra-anatomic bypass (n=7), in situ reconstruction (n=50), and patch plasty (n=3); 2 patients died intraoperatively. EVAR was performed in 70 patients (53%): standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stent grafting (n=7); no deaths occurred intraoperatively. Survival at 3 months was lower for OR than for EVAR (74% versus 96%, P<0.001), with a similar trend present at 1 year (73% versus 84%, P=0.054). A propensity score-weighted risk-adjusted analysis confirmed the early better survival associated with EVAR. During median follow-up of 36 and 41 months for OR and EVAR, respectively, there was no difference in long-term survival (5 years 60% versus 58%, P=0.771), infection-related complications (18% versus 24%, P=0.439), or reoperation (21% versus 24%, P=0.650). This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR was associated with improved short-term survival in comparison with OR, without higher associated incidence of serious infection-related complications or reoperations.