We report the usefulness of live three-dimensional transthoracic echocardiography (3DTTE) in the morphological assessment of a left ventricular thrombus. Using live 3DTTE, the thrombus could be easily viewed end-on and from the sides. In addition, by cropping the 3D images sequentially in transverse (horizontal or short axis), longitudinal (vertical or long axis), frontal, and oblique planes, the degree and extent of lysis within the thrombus, which represents an integral part of the clot-resolution process, could be comprehensively assessed. The site of attachment of the thrombus in the left ventricular apex and its morphology could also be fully evaluated in three dimensions by live 3DTTE.
Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.
India is experiencing accelerated demographic transition. The country will face the challenge of dealing with problem of population aging in the coming decades. Amidst socioeconomic consequences, health risks among older adults are rising rapidly especially on account of noncommunicable diseases. Given such background, this study assesses the pattern of disease burden, health care utilization, and their covariates for older adults in two selected states based on the 60th round of National Sample Survey (NSSO) data. The states in focus are Maharashtra, the state ahead in demographic transition, and Uttar Pradesh, the state lagging in this process. Correspondingly, the overall prevalence of noncommunicable diseases is higher in Maharashtra compared with Uttar Pradesh. Multivariate logistic regression estimates further show that both the morbidity and health care utilization rates are increasing among older adults. At the same time, substantial disparities are demonstrated in the pattern of morbidity prevalence and health care utilization among older persons by demographic and socioeconomic factors and between Maharashtra and Uttar Pradesh.
In the process of health transition, India is facing rapid pace of demographic aging. Rapid increase in older adult population posed serious concerns regarding health and health care utilization for them. However, very limited research documented resultant implications of demographic aging for health and health care use in the nexus of marital status and gender. With this perspective, the present study examined patterns in morbidity prevalence and health seeking behaviour among older widows in India. Multivariate logistic regression models were estimated to examine the effects of socio-demographic conditions on morbidity prevalence among older widows and their health care seeking behavior. Data from the latest 60th round of National Sample Survey (NSS), 2004 was used. Overall, morbidity prevalence was 13% greater among older widows compared to older widowers. Adjusted prevalence of communicable and non-communicable diseases was found 74 and 192 per 1000 older widows respectively. At the same time, likelihood of seeking health care services for reported morbidities was substantially lower among older widows. The findings of this study are important to support policy makers and health care providers in identifying individuals ‘at risk’ and could be integrated into the current programs of social, economic and health security for the older persons.
In the present study, we compared three‐dimensionally (3‐D) reconstructed images with multiplane two‐dimensional (2‐D) transesophageal echocardiographic (TEE) images in 17 patients with various cardiac masses and defects. To overcome the problem of making measurements from 3‐D reconstructed images, we carefully “dissected” the 3‐D dataset using paraplane and anyplane 2‐D sections, which were then used to obtain the maximum sizes of the cardiac masses and defects. Of the 15 vegetations and 9 abscesses detected by 3‐D TEE in 7 patients, only 8 (53%) vegetations and 4 (44%) abscesses were detected by multiplane 2‐D TEE (P < 0.02). Also, the exact anatomical location, shape, geometry, and extent of various cardiac masses and defects were more clearly delineated by 3‐D than 2‐D TEE. The maximum dimensions of cardiac masses and defects were larger by 3‐D than by 2‐D TEE in 17 (89%) of the 19 lesions available for comparison (P < 0.002). In addition, 3‐D TEE correlated more closely than 2‐D TEE when compared to surgical measurements in three patients in whom they were available. Thus, it would appear that in several instances, the exact size of the cardiac lesion could only be assessed by analysis of the 3‐D volumetric dataset. Out preliminary study has demonstrated the superiority of transesophageal 3‐D reconstruction over multiplane 2‐D TEE in both qualitative and quantitative assessment of various cardiac mass lesions and pathological defects.
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