European Journal of Cardiovascular Medicine

Background: The Inferior Vena Caval Collapsibility Index (IVCCI) is a simple, non-invasive ultrasonographic tool to assess intravascular volume status and fluid responsiveness. In spinal anaesthesia (SA), hypotension is a common complication, often related to preoperative hypovolemia from fasting. Identifying fluid-responsive patients preoperatively may help prevent intraoperative hypotension. However, limited studies have evaluated IVCCI for this purpose. Aim: To evaluate preoperative IVCCI and correlate it with hemodynamic changes following spinal anaesthesia. Methods: An observational study was conducted on 80 ASA I and II patients undergoing elective surgery under SA. Preoperatively, an 18G IV line was secured, and inferior vena cava (IVC) diameters during inspiration and expiration were measured using a 2–6 MHz curvilinear probe in the subcostal long-axis view with M-mode ultrasound. IVCCI was calculated as: IVCCI = [(IVCₑₓ – IVCᵢₙ) / IVCₑₓ] × 100 Patients were then given 500 mL Ringer Lactate over 15 minutes, and IVC measurements were repeated. After SA, hemodynamic parameters (SBP, DBP, MAP, HR) were recorded every 10 minutes. Results: Pre-bolus mean IVCCI was 40.51% (SD 3.06), suggesting preoperative hypovolemia. Post-bolus IVCCI reduced to 36.37% (SD 2.17), indicating fluid responsiveness. A significant negative correlation was found between IVCCI and hemodynamic parameters, especially MAP (r = -0.2, p < 0.0001). Conclusion: IVCCI is a useful, bedside predictor of fluid status and responsiveness. A preoperative fluid bolus effectively reduces IVCCI and helps maintain intraoperative hemodynamic stability in patients undergoing spinal anaesthesia. Incorporating IVCCI assessment into routine preoperative evaluation may help anticipate and manage SA-induced hypotension.

Background: Peak expiratory flow rate (PEFR) is influenced by various anthropometric factors, with conflicting evidence regarding the relationship between body mass index (BMI) and respiratory function in children. Objective: To investigate the correlation between BMI and PEFR in healthy school-going children aged 8-15 years and assess the influence of demographic, anthropometric, and environmental factors. Methods: A cross-sectional study was conducted among 208 healthy school children aged 8-15 years in secondary schools of Hyderabad, India. Anthropometric measurements including height, weight, and BMI were recorded. PEFR was measured using Mini Wright's peak flow meter. Statistical analysis included Pearson correlation, simple linear regression, and multiple linear regression analyses. Results: The study population comprised 117 males (56.3%) and 91 females (43.8%) with mean age 9.53±1.34 years. Simple linear regression showed BMI had a weak positive correlation with PEFR (r=0.20, p<0.001). Height demonstrated the strongest correlation with PEFR (r=0.63, p<0.001), followed by age (r=0.54, p<0.001) and weight (r=0.47, p<0.001). In multiple regression analysis controlling for confounding variables, BMI's influence on PEFR became non-significant, while age, gender, and exposure to mosquito repellents remained significant predictors. Conclusion: BMI shows a weak positive correlation with PEFR in isolation, but this relationship is not significant when controlling for other variables. Height, age, and gender are stronger predictors of PEFR in children. The apparent BMI-PEFR relationship is likely mediated by other anthropometric and demographic factors

Stroke is a leading cause of morbidity and mortality worldwide, contributing substantially to global disease burden. Ischemic strokes account for nearly 85% of all stroke cases and are associated with substantial neurological deficits. Serum calcium plays a pivotal role in neuronal function, and its dysregulation during cerebral ischemia has been implicated in worsened neuronal injury. This study was conducted to investigate the relationship between serum calcium levels and infarct size among patients with acute ischemic stroke. Fifty patients aged above 40 years, diagnosed radiologically by CT scan, were included. Serum calcium and albumin were measured, and corrected calcium was calculated. Infarct size was estimated using the ABC/2 method. Statistical analysis revealed a significant negative correlation between serum calcium and infarct size (r = -0.2933, p = 0.04). Corrected calcium demonstrated a stronger inverse correlation (r = -0.6303, p = 0.01). These findings suggest that lower serum calcium levels are associated with larger infarct sizes, highlighting the potential role of serum calcium as a prognostic biomarker in acute ischemic stroke.

Background: Diabetes mellitus is a major risk factor for coronary artery disease (CAD), yet the relative angiographic severity of CAD across the glycemic spectrum—including pre-diabetes—remains incompletely defined. Methods: We conducted a cross-sectional observational study of 412 consecutive patients presenting with a first episode of acute coronary syndrome (ACS) who underwent coronary angiography. Patients were classified as diabetic (n = 213), pre-diabetic (n = 76), or non-diabetic (n = 123) according to ADA criteria. The severity of CAD was quantified using the Gensini scoring system. Associations between glycemic status, HbA1c, duration of diabetes, and angiographic severity were analyzed using ANOVA and Pearson’s correlation. Results: The mean Gensini score was 47.1 ± 31.1 in diabetics, 41.5 ± 25.1 in pre-diabetics, and 38.5 ± 33.9 in non-diabetics (p = 0.049). Triple-vessel disease was most prevalent in diabetics (29.1%) compared with pre-diabetics (14.5%) and non-diabetics (14.6%, p< 0.001). Duration of diabetes correlated strongly with CAD severity (r = 0.69, p< 0.001), with patients having >10 years’ diabetes showing the highest mean Gensini score (85.0) versus 34.5 in newly detected cases. In contrast, HbA1c stratification (<6.5%, 6.5–8.9%, >9%) showed no significant association with severity (p = 0.484). Low HDL cholesterol was the most common lipid abnormality across all groups (63–73%). Correlation analyses revealed significant associations between Gensini score and glycemic indices in diabetics (RBS p = 0.0001, FBS p = 0.0079, PPBS p = 0.0043), whereas in non-diabetics, FBS (p = 0.012) and PPBS (p = 0.008) also correlated with CAD burden. Conclusion: Diabetic patients with ACS exhibited the greatest angiographic severity of CAD, followed by pre-diabetics and non-diabetics. The duration of diabetes, rather than HbA1c at a single point in time, was the strongest determinant of severity. These findings emphasize the cumulative impact of chronic hyperglycemia on atherosclerotic burden and underscore the importance of early detection and aggressive management in both diabetes and pre-diabetes to reduce the risk of severe, multi-vessel coronary disease.

Background: Vitamin D, traditionally known for its role in bone metabolism, is now recognized as a pleiotropic hormone with significant immunomodulatory and metabolic functions. A growing body of evidence suggests a link between vitamin D deficiency and the pathogenesis and control of type 2 diabetes mellitus (T2DM). However, the prevalence and clinical correlates of this deficiency vary across populations. Methods: We conducted a cross-sectional study involving 412 adult patients with T2DM attending a tertiary care diabetes clinic. Data on demographics, duration of diabetes, and current medications were collected. Fasting blood samples were analyzed for serum 25-hydroxyvitamin D [25(OH)D] and glycated hemoglobin (HbA1c). Vitamin D status was categorized as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL). Patients were also stratified by glycemic control (good: HbA1c <7.0%; moderate: HbA1c 7.0–8.0%; poor: HbA1c >8.0%). Results: The mean age of the cohort was 58.6 ± 10.2 years, with a mean diabetes duration of 11.4 ± 6.8 years. The overall mean serum 25(OH)D level was 21.3 ± 9.5 ng/mL. The prevalence of vitamin D deficiency was 46.1% (n=190), while 30.3% (n=125) were insufficient, yielding a combined prevalence of hypovitaminosis D of 76.4%. A significant inverse relationship was observed between vitamin D levels and glycemic control. The mean 25(OH)D level was significantly lower in patients with poor glycemic control (17.8 ± 7.2 ng/mL) compared to those with good control (26.5 ± 8.1 ng/mL; p<0.001). Furthermore, Pearson correlation analysis revealed a significant negative correlation between serum 25(OH)D and HbA1c (r = -0.42, p<0.001). Patients with a longer duration of diabetes (>10 years) also had significantly lower mean 25(OH)D levels than those with a shorter duration (<5 years) (18.9 ± 8.5 ng/mL vs. 24.1 ± 9.8 ng/mL; p=0.002). Conclusion: Vitamin D deficiency and insufficiency are highly prevalent among patients with T2DM. Lower vitamin D status is significantly associated with poorer glycemic control and longer disease duration. These findings suggest that screening for and potentially correcting vitamin D deficiency should be considered as part of the comprehensive management of patients with T2DM

Background: Ophthalmia neonatorum (ON) is an important cause of neonatal morbidity, ranging from conjunctivitis to corneal ulceration and blindness. Although preventive strategies exist, etiological patterns vary, with non–sexually transmitted bacteria now common. Prospective Indian data on maternal and perinatal risk factors remain limited. This study aimed to describe the clinical spectrum, microbiological profile, outcomes, and risk factors associated with severe ON. Materials and Methods: A prospective observational study was conducted in the Departments of Ophthalmology and Pediatrics, Mamata Medical College, Khammam, over 12 months. One hundred neonates (≤28 days) with conjunctivitis were enrolled. Maternal and perinatal histories were recorded, and ocular examination included laterality, discharge, congestion, lid edema, membranes, corneal involvement, and anterior chamber reaction. Conjunctival swabs were subjected to Gram stain and culture on blood agar, MacConkey, chocolate, and Thayer–Martin media. Antimicrobial susceptibility testing followed CLSI guidelines. Follow-up was performed at 48–72 hours, 7 days, and 14 days. Results: Of 100 neonates, 62% were delivered vaginally, 28% were preterm, and 22% had low birth weight. PROM was present in 20% and maternal infection in 18%. Clinically, mucopurulent discharge (65%) was most frequent; membranes, corneal involvement, and anterior chamber reaction occurred in 12%, 8%, and 3% respectively. Culture positivity was 76%; Staphylococcus aureus (32%) and coagulase-negative staphylococci (18%) predominated, while N. gonorrhoeae was isolated in 2 cases. Isolates showed high sensitivity to ciprofloxacin and ceftriaxone, with reduced sensitivity to erythromycin. Clinical improvement occurred in 62% by 72 hours, 85% by 7 days, and 94% by 14 days. Severe outcomes correlated with inadequate antenatal screening, PROM, and maternal infection. Conclusion: Staphylococcal species were the leading causes of ON, with gonococcal cases rare. Most neonates improved with timely therapy, but perinatal risk factors predicted severity. Strengthening antenatal care, infection control, and culture-guided management is vital to reduce morbidity.

Background: Congenital variations in coronary anatomy are uncommon, and complete absence of the left main coronary artery (LMCA) with a right coronary artery (RCA) supplying almost the entire heart is exceptionally rare. In such cases, the myocardium depends entirely on a single dominant vessel, so any blockage can cause extensive ischemia and carry a high risk of sudden death. Detecting this pattern early through modern imaging is important for accurate diagnosis and planning preventive or therapeutic interventions. Methods: A 47-year-old man experienced intermittent, non-radiating chest discomfort over ten days. Clinical evaluation was unremarkable. ECG showed a left bundle branch block, while cardiac enzyme levels were within normal range. Echocardiography revealed mild segmental wall motion changes in the left ventricle with preserved ejection fraction (~50%). Conventional coronary angiography suggested absence of LMCA with retrograde filling of left-sided branches from the RCA. Computed tomography (CT) coronary angiography was performed to clarify vessel anatomy, calibre, and distribution, and the findings were reviewed in relation to the Lipton–Yamanaka classification. Results: CT imaging demonstrated complete absence of the LMCA. The left coronary system arose as two small-calibre arteries from the left coronary sinus: a hypoplastic left anterior descending artery (1.3 mm diameter, containing a 3.8 cm segment of myocardial bridging, poorly visualized distally) and a hypoplastic left circumflex artery (1.1 mm diameter, non-dominant, continuing as obtuse marginal). The RCA originated from the right coronary sinus, measured 4.5 mm in diameter, and was superdominant, supplying the posterior descending artery, posterolateral ventricular branches, inferior wall, and most of the lateral wall. The vessel showed no signs of atherosclerosis. This anatomical combination did not match any existing Lipton–Yamanaka subtype. Conclusion: This case illustrates an extremely rare coronary configuration involving absent LMCA, markedly underdeveloped LAD and LCx, and a superdominant RCA supplying the majority of the myocardium. Such dependence on a single vessel greatly magnifies the consequences of any obstruction. The mechanism of symptoms in these anomalies may involve small vessel calibre, myocardial bridging, or altered flow dynamics rather than plaque disease. CT coronary angiography is invaluable for defining anatomy, assessing risk, and guiding safe management

Background: Beta Thalassemia Trait (BTT) is a significant public health concern, particularly in India, due to its high prevalence. Early detection through cost-effective screening methods is crucial, especially in low-resource settings where High-Performance Liquid Chromatography (HPLC) is not readily available. Objective: This study aimed to evaluate the diagnostic reliability of hematological indices in detecting BTT among pregnant women, using HPLC as the gold standard. Materials & Methods: A retrospective study was conducted at a tertiary care center in eastern India, analyzing 3,249 pregnant women with hemoglobin levels <11.0 g/dL attending the antenatal clinic between October 2022 and September 2023. CBC, PBS, serum iron, serum ferritin, and HPLC were performed. BTT was diagnosed in 103 women (Hb A₂ >3.5%), and the sensitivity, specificity, PPV, and NPV of hematological indices (Mentzer Index, RDW Index, Shine & Lal Index, Srivastav Index) were assessed. Results: Among 103 confirmed BTT cases, the Shine & Lal Index had the highest sensitivity (99.01%) and NPV (99.5%), correctly identifying 102 cases. Mentzer’s Index detected 24 cases (23.3%), Srivastav Index 21 (20.38%), and RDW Index 33 (32.03%). While all indices had high specificity (>99%), Shine & Lal Index had the highest overall accuracy (74%). Conclusion: The Shine & Lal Index is a reliable, cost-effective screening tool for BTT in pregnant women, particularly in low-resource settings where HPLC is unavailable. Early detection enables timely genetic counseling and intervention.