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  • ISSN: 2333-6676
    Volume 8, Issue 2
    Research Article
    Sarvesh Kumar, Vivek Tewarson, Mohammad Zeeshan Hakim, Shobhit Kumar, and Sushil K Singh*
    Introduction: Chronic constrictive pericarditis is a significant cause for diastolic dysfunction of the heart. Tuberculosis is considered a significant etiology in developing countries, whereas idiopathic cases are most common world-wide. Although pericardiectomy is an established procedure for chronic constrictive pericarditis, the extent of resection and utility of cardiopulmonary bypass is still debatable. The aim of this study was to study the feasibility and surgical outcomes of pericardiectomy for this disease in a large patient group in today’s scenario.
    Materials & methods: We retrospectively analyzed data of all patients who underwent pericardiectomy at our center between 2005 to 2019. We collected data of precise etiopathology of constrictive pericarditis. Analysis of surgical approach and outcomes was done. Inclusion criteria involved all consecutive patients with a diagnosis of constrictive pericarditis.
    Results: A total of 311 patients underwent pericardiectomy. Good surgical outcomes were demonstrated. There was a significant improvement in the functional status after surgery. Tuberculosis was the predominant etiology as seen in 48.23% cases, while idiopathic cases constituted 42.12%. Adequate removal of pericardium in all cases was possible without resorting to cardiopulmonary bypass and 23.15% patients could be operated through left antero-lateral thoracotomy. In-hospital mortality was 1.6%.
    Conclusion: Tubercular pericarditis is still a common etiology of pericardial disease in our set-up and pericardiectomy carried out without use cardiopulmonary bypass can achieve excellent results for such cases.
    Taizen Nakase, Yoshiko Takahashi, Aiko Hata, Junta Moro, Tatsuya Ishikawa, and Hiroaki Shimizu
    Purpose: Stroke severity has been reported to be milder in patients taking direct oral anticoagulant (DOAC), compared with those taking warfarin. However, since elderly patients tend to have multiple complications, it is under debate whether such preferable effect of DOAC can be expected even in elderly patients. Therefore, we aimed to reveal if there is any difference of clinical manifestation between elderly and younger stroke patients who had been treated with DOAC.
    Methods: From the consecutive acute ischemic stroke patients between April 2015 and March 2019, embolic stroke patients with anticoagulant medication by DOAC prior to the index stroke were selected in this study (n=55). The elderly was defined as aged over 80 years-old. Appropriate dosing of DOAC was determined by drug information documents. Clinical characteristics, neurologic severity, ischemic lesion size and outcome were accessed between patients over 80 years-old (=80) (n=24) and less than 80 years-old (<80) (n=31).
    Results: Appropriate dosing rate was significantly higher in the = 80 compared with the <80 groups (87.5% and 61.3%, respectively: p=0.037). Neurologic severity on admission and the outcome at discharge were not significantly different between two groups. The distribution of lesion size was not different between the = 80 and the <80 groups within patients taking appropriate dosing of DOAC.
    Conclusion: It can be said the preferable effects of DOAC might be expected even in elderly patients as long as appropriate dose is prescribed.
    Lairikyengbam SKS*, Ramdeo Yadaveb, Athokpam Swarnamayee Devic, and Sanjeeta Devid N
    Acute Coronary Syndrome (ACS), Registry in northern India showed an additional one hour delay of Door to Needle Time (DNT), in the initiation of thrombolytic therapy for acute ST-Elevation Myocardial Infarction (STEMI) increases the hazard ratio of death by 20%. A retrospective observational study of 75 patients with acute STEMI treated at the Dedicated Heart Attack Centre (HAC) of SKY Hospital and Research Center, Imphal, India between January 2018 and February 2020 showed a reduction of DNT and an improvement of 30 minutes thrombolysis time to 76% from 35.6% where such dedicated HAC is unavailable.
    Mini Review
    Verlyn Yang BMed* and Pascalino Romeo
    Pulmonary embolism (PE) as a complication of routine modern Ophthalmic surgery is rare and almost never discussed with patients. A review of the literature.
    Editorial
    Ian Oliver Patient*, and Tom Treasure professor
    In April 2010 I noticed that almost overnight I had developed a beer belly. As I do not drink much alcohol and am normally slim I began to worry. About this time I also became breathless and easily fatigued, and I developed swollen ankles caused by fluid retention. My general practitioner referred me to my local hospital for an ultrasound, which indicated that I had a swollen spleen and liver.
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