BackgroundIt has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic.MethodsThis was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown.Results25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block.ConclusionThe COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.

Aims Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. Methods and resultsThe NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. Conclusion One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.

Painted stork (Mycteria leucocephela) is a large resident wetland bird of stork family- Ciconidae and has been categorized as near threatened. A new nesting colony of wild Painted stork, breeding along with Lesser (Leptoptilos javanicus) and Greater Adjutant stork (Leptoptilos dubius) have been observed on the same nesting tree (Kadamb- Anthocephalus cadamba) at Bagritola village of Kadwa panchayat located on the flood plains of the Kosi river in district of Bhagalpur, Bihar, India. In October, 2015, a single nest and three Painted storks were observed (of which one bird was seen incubating) on a Kadamb tree in the village Bagritola. This breeding site was studied from October, 2015 to March, 2020 to observe the detailed nesting and breeding behaviors. From October, 2015 onwards a significant increase in the number of nests of Painted storks was recorded at the same breeding site and the storks adopted 2-5 separate but closely situated kadamb trees for nesting. In the month of September, 2017, two adjacent Kadamb trees were adopted by the Lesser and Greater Adjutant storks for nesting and they built two nests (one on each) Kadamb tree. In October, 2017, Painted storks also started to build their nest on the same trees which were already occupied by the Adjutant storks. From 2018 onwards, no nests of Lesser adjutant stork were observed and the Painted storks were found to breed along with Greater adjutant storks only, till the end of the study period i.e. March, 2020. Similar to the other two stork species, both the male and female Painted storks were sharing the process of nest building, incubation, nursing and guarding the chicks by rotation. Fragments of old branches of nearby trees as well as from abandoned nests were used for building the nests which were cushioned with the leaves. The Painted storks were successfully breeding along with the Greater adjutant storks on the same nesting trees peacefully without any obvious disturbances. The breeding season of Painted storks was observed to continue between October to March and their incubation period was estimated to range between 27-30 days. The breeding season of Lesser adjutant stork was observed to continue between mid-August to Feb whereas of Greater adjutant stork was observed between September to March with slight variation of 6-10 days in Bihar, India.

Cor triatriatum sinistrum (division of the left atrium) is a recognized clinical and surgical entity. Division of the right atrium, also known as cor triatriatum dexter, is an extremely rare congenital abnormality in which persistence of the right valve of the embryonic systemic sinus venosus divides the right atrium into two chambers. Typically, the right atrial partition is due to exaggerated fetal eustachian and thebesian valves, which together form an incomplete septum across the lower part of the atrium. This septum may range from a reticulum to a substantial sheet of tissue. Cor triatriatum dexter can be diagnosed at any age, especially if it is incidentally discovered. Usually, this anomaly is recorded at necropsy. This report describes the case of a divided right atrium evaluated for nonspecific symptoms and unexplained cardiomegaly with right atrial enlargement.

Background: Gallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population. Methods: A retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used. Results: Of 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031). Conclusion: Cholecystectomy needs to be considered early in the management of small- sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.