Introduction: Elevated C-Reactive Protein (CRP) is a predictive marker for future cardiovascular events in ischaemic stroke patients but the timing of CRP evaluation in relation to the onset of the qualifying event has not been determined. Aim: To study the predictive accuracy of CRP in relation to adverse outcome of patients with acute ischaemic stroke. Materials and Methods: This prospective single centre, observational study was conducted on 62 cases of acute ischaemic stroke admitted to the Department of Medicine, SCB Medical College and Hospital, Cuttack, Odisha, India. CRP was determined quantitatively in all the patients of ischaemic stroke both at the time of admission and discharge. The CRP value was correlated with infarct size (Computed Tomography (CT) scan), mortality, morbidity (disability i.e., Barthel Index (BI), Canadian Neurologic Stroke Scale (CNSS) and vascular events). The end points were death or any new non fatal vascular events (recurrent stroke, unstable angina, myocardial infarction) recorded during six months of follow-up period. Results: CRP at admission correlates with the occurrence of fatal events only but CRP at discharge correlates with occurrence of both fatal and non fatal events. On follow-up occurrence of events correlates more strongly with CRP at admission. Out of total 14 non fatal events, maximum was restroke i.e., 7 (50%) which occurs in high CRP group. BI (degree of disability), both on admission and at six months strongly correlated with CRP at discharge (p-value=0.008 and 0.001 respectively). Conclusion: The severity of stroke and degree of disability was highest in high CRP group. The CRP at discharge was a better predictor of future outcome in terms of fatal and non fatal events than CRP at admission.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic challenged the healthcare infrastructure, with healthservice providers (HSPs) offering unconditional and unprejudiced service to admitted patients. During the first wave, due to the novelty of the disease and the lack of clarity regarding its transmission in the initial phases of the evolution of the disease, the predominant fear was of contracting the disease while caring for patients. With the prevailing uncertainty in knowledge and management, this study was planned to identify the barriers to delivering optimal healthcare to COVID-19 patients. MethodologyA cross-sectional study was conducted among HSPs working in the first phase of a dedicated 500-bed government COVID-19 hospital at Kalinga Institute of Medical Sciences using an online questionnaire with the following five aspects: workplace guidelines and support, protective equipment, access to information regarding updates on the epidemic, overall self-reported stress and workplace stress about self-infection with COVID-19 and family being infected, and demographics. All HSPs aged 18 years or above, who were working either on a full-or a part-time basis, were able to understand the English language, and who were working in the COVID-19 hospital and gave digital informed consent (via Google Forms) were included in the study. All data were collected, coded, tabulated, and analyzed using Google Forms in an Excel format and Epi Info software version 7.2.5.0. ResultsOf the 144 respondents contacted, 132 completed the survey, with a participation rate of 91.67%. About 52.27% of respondents were aged 21-30 years, 68.18% were females, and 56.06% were nurses. Challenges faced were "working in a new context" (40.91%), "the uncertainty and fear of being infected and infecting others"(31.06%), and "exhausted by the workload and protective gear" (18.94%). Moreover, 64.12% were aware of a workplace policy. Only 0.75% felt that their workload needed to be reduced; 2.27% felt the need for a penalty policy for hiding travel history, lack of quarantine compliance, avoiding the accumulation of face masks, and price inflation of face masks. The overall self-reported stress level was significantly associated with a lack of awareness of workplace policies and the fear of getting infected. Furthermore, 93.94% reported that they had an adequate supply of personal protective equipment. As high as 81.06% of the HSPs were "worried about being infected from COVID-19 during work," and 94.69% were "worried about their family being infected from COVID-19 due to their working in COVID-19 hospitals." ConclusionsHSPs' perception of barriers in providing healthcare gave an insight into the problems being faced and helped improve the quality of services. The study highlighted the need of increasing awareness regarding the existing workplace policies among HSPs to promote preparedness during crisis management.

Background: In order to facilitate diagnosis and timely intervention, it is essential to understand the presentation pattern of cardiac symptoms, and distribution of risk factors in women with Coronary Artery Disease (CAD). However, limited data is available regarding the salient features of CAD in women like distribution of risk factors and anatomical extent. Aims and Objective: The purpose of the present study was to determine the clinical and risk factor profile of women admitted with CAD and to analyze their angiographic findings in relation to the clinical presentation and risk factors in a tertiary care referral center of eastern India. Materials and Methods: In this study we prospectively analysed risk factors and angiographic patterns of 140 consecutive female patients who underwent coronary angiography for suspected CAD over a period of 2 years. Results: CAD most commonly affected females of age group >60yrs with higher incidence among postmenopausal as compared to premenopausal women. Unstable angina was the commonest presentation among patients with normal coronaries as well as obstructive CAD.A substantial percentage of women presenting with anginal pain were angiographically normal. Hypertension was the most common associated risk factor followed by diabetes, elevated total cholesterol, high LDL & low HDL. Most common coronary angiography finding was single vessel disease. On analysis, diabetes mellitus, elevated cholesterol, elevated LDL & triglycerides were most commonly associated with triple vessel disease. Conclusion: The incidence of CAD in females increased with age. Single vessel disease was the commonest presentation with Left Anterior Descending Artery, the most frequently involved vessel.

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To compare the clinico-biochemical profile of young patients (< 40 years) having coronary artery disease (CAD) with age-sex matched controls with a special reference to lipoprotein (a) [Lp(a)] and comprehensive lipid tetrad index (CLTI).