Background:We aimed to identify the risk factors for epilepsy in children.Materials and Methods:This case–control retrospective study was carried out in the pediatric neurology outpatient service of the Trivandrum Medical College. All children (1–12 years) with epilepsy satisfying the selection criteria were included, after obtaining consent from parents. Those with single seizures or febrile seizures were excluded. Controls were children without epilepsy attending the same hospital. Parents were interviewed and clinical data were obtained from medical records. Statistical analysis included chi-square test, odds ratio (OR), and logistic regression.Results:There were 82 cases and 160 controls whose mean age was 6.9 + 3.6 and 5.2 + 3.1, years respectively. On univariate analysis, family history of epilepsy, prolonged labor, cyanosis at birth, delayed cry after birth, admission to newborn intensive care unit, presence of congenital malformations, neurocutaneous markers, incessant cry in the first week, delayed developmental milestones, meningitis, encephalitis, and head trauma were found to be significant. On logistic regression, family history of epilepsy (OR 4.7), newborn distress (OR 8.6), delayed developmental milestones (OR 12.6), and head trauma (OR 5.8) were found to be significant predictors. Infants who had history of newborn distress are likely to manifest epilepsy before 1 year if they are eventually going to have epilepsy (OR 3.4).Conclusion:Modifiable factors such as newborn distress and significant head trauma are significant risk factors for childhood epilepsy. Newborn distress is a risk factor for early-onset (<1 year age) epilepsy.

While dissecting the thorax, when the pericardium was opened, massive clots were seen, concealing the heart. The experience was used to teach about pericardial pericardial tamponade, which most probably caused the death of the “patient.” The concept of how the intrapericardial pressure builds up to compromise cardiac hemodynamics, how it can be clinically suspected, rapidly investigated, and managed as a medical emergency, was taught. This incident was an eye-opener that the time-tested cadaveric dissection should never be entirely replaced by alternatives though they may be wisely and effectively used to complement dissection.

No abstract

We describe here an approach to a ventricular septal rupture in a patient with a recent myocardial infarction. We briefly describe how we decided the route, the type of device and the procedure we followed. We also detail how we followed up the patient. We performed the VSR closure 5 days after the index infarction as the patient was in hypotension. The ventricular septal rupture was crossed with a Terumo wire covered by a right coronary guide catheter passing from the left ventricle to the right ventricle via a right femoral artery approach and the right internal jugular vein was used to form an arteriovenous loop. Using a patent ductus arteriosus sheath the ventricular septal rupture was crossed and a 16 mm Amplatzer ASD closure device was deployed. The patient had a mild residual leak and tolerated the procedure well.We have also included a few words from various authors who have attempted VSR closure including some from 2019.

Introduction: Platelets play a vital role in systemic inflammation and thrombus formation in ST Elevation Myocardial Infarction (STEMI). Understanding its role has diagnostic and prognostic implications in developing therapeutic strategies. Aim: To estimate the prognostic accuracy of platelet indicesMean Platelet Volume (MPV), Platelet Distribution Width (PDW) and MPV/Platelet Count (PC) Ratio (MPV/PC ratio) on reperfusion outcome in STEMI patients. Materials and Methods: This prospective cohort study enrolled 262 subjects, who presented with acute chest pain within a window period of 12 hours, and an Electrocardiogram (ECG) suggestive of STEMI. Blood samples collected on admission were measured for MPV and PDW. The major endpoints studied were angiographic thrombus burden and in-hospital Major Adverse Cardiovascular Events (MACE). Data was summarised by Mean and SD for continuous variables, frequency and percentage for categorical variables. Results: This study demonstrated that Acute Coronary Syndrome- STEMI (ACS-STEMI) patients with larger PDW had Larger Thrombus Burden (LTB). PDW of more than 13 fL was the best cut off for predicting LTB with a sensitivity of 67.01% and a specificity of 53.23%. There was no significant difference between the means of MPV in LTB and small thrombus burden. The total in-hospital MACE at the end of one week was 20.99% (n=55/262 patients). The maximum MACE was contributed by acute heart failure (12.6%), followed by cardiac death (6.1%) and stent thrombosis (1.5%). There was a significant association between increased PDW and in-hospital MACE, mortality and acute heart failure (p-value=0.024, p-value=0.03, p-value=0.02, respectively). The best cut-off PDW value for prediction of the composite MACE endpoint was 14.7 fL with sensitivity of 75.6% and specificity of 51.4% and the area under the Receiver Operating Characteristic (ROC) curve was 0.63 (95% CI, 0.57 to 0.69). Conclusion: The study emphasises the use of platelet indices, especially PDW, as a predictor of poorer reperfusion outcomes in primary Percutaneous Coronary Intervention (PCI) as evidenced by higher MACE rates in patients with higher PDW. Hence, PDW can help in predicting the thrombus burden even before doing the angiogram and such high-risk patients could benefit from early initiation of stronger antiplatelets, Gp IIb/IIIa (Glycoprotein) antagonist drugs and thrombus aspiration techniques.