Aim Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. Methods & Results In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = −0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. Conclusions The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.

Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Background: As HIV/AIDS has emerged to be the first modern pandemic with ever increasing prevalence globally, the present study was undertaken to study the renal profile in patients living with HIV/AIDS, not started on ART. Materials and methods: This was a hospital based observational study where 277 cases were studied in details with the aims and objectives of studying the renal manifestations in ART naïve patients with HIV/AIDS and its relationship with CD4 counts. A detailed history, clinical examination and relevant investigations were done in patients above 15 yrs of age who were not on ART. Results: Out of 277 seropositives, 40 had proteinuria (14.44%) on urine examination. The mean serum creatinine of the total study population was found to be 0.92±0.83 mg/dl while 14 cases (5%) had serum creatinine more than 1.5mg/dl. A decrease in eGFR (<60ml/min/1.73m 2) was seen in 28 (10.1%) cases. Out of 178 cases with CD4 count more than 200cells/mm 3 , renal dysfunction was found in 12 cases (6.7%), whereas the cases with CD4 count less than or equal to 200cells/mm 3 , 19 out of 99 cases (19.2%) had renal dysfunction which is statistically significant. Conclusion: In the present study, which included ART naive patients with HIV/AIDS, predominant renal involvement was in the form of proteinuria followed by raised serum creatinine levels and reduced eGFR. A negative correlation was found between renal dysfunction and CD4 counts.

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Rh immunization: About 8.5 0, of 760 mothers developed Rhesus antibodies six months after first pregnancy, and a further 8.500 by the end of the second pregnancy. Evidence is presented of relation between post-delivery foetal cell count and risk of developing antibodies (p. 139) ; Leader at p. 135. Calcium and Dialysis: Metastatic calcification considered less likely after calcium concentration is raised to optimum level (p. 145) ; Group of patients with terminal renal failure developed parathyroid autonomy, but function tended to revert to normal with continued dialysis (p. 150). Common Cold: Influenza C virus caused respiratory tract disease in 26 volunteers, and 9 had common cold symptoms (p. 153). Perforated D.U.: Vagotomy and pyloroplasty performed as emergency gave equally satisfactory results as elective surgery when compared over a six-year period (p. 155). Sight Testing: Use of blocks instead of letters with young children proved a satisfactory method (p. 157). Pregnancy and Vitamin B12: Caution recommended in administering folate unless serum B12 levels measured, especially in older women (p. 158) ; Survey showed B12 levels higher in West Indian population than in Europeans even during pregnancy (p. 160). Case Reports: Cyclophosphamide for oesophageal cancer (p. 161) ; Congenital cytomegalovirus infection (p. 162). Psychiatry: Emergencies in general practice (p. 164). Today's Drugs: Vitamin B12 (p. 167). Surgeon's " Assistant ": " Snake " arm appliance described (p. 170). Athletics at Altitude: Review of Medicine and Sport (p. 171). Transplantation: Survey of experimental basis of cardiac transplantation in man (p. 174). Personal View : Dr. W. Dewi Rees (p. 182). G.P. Obstetric Units : More letters (p. 189). " Under the Influence ": Drug taking, criminal responsibility, and the Law (p. 197). Motor Show: Emphasis on safety and design in new cars (p. 196). Green Paper: Discussed by C.C.H.M.S.