European Journal of Cardiovascular Medicine

To assess serum vitamin B12, folate, and iron levels in children aged 6–59 months with severe acute malnutrition (SAM) admitted to the Nutritional Rehabilitation Centre (NRC) at Hassan Institute of Medical Sciences (HIMS), Hassan. Background: SAM is associated with anaemia and micronutrient deficiencies that may adversely affect growth, development, and recovery. Iron, vitamin B12, and folate are essential for normal erythropoiesis, and their deficiencies may coexist. Methods: This hospital-based cross-sectional analytical study included 100 children aged 6–59 months diagnosed with SAM according to World Health Organization criteria. Clinical history, feeding practices, and anthropometric measurements were recorded. Haematological parameters, peripheral smear findings, and serum vitamin B12, folate, and iron levels were assessed, and associations between anthropometric and laboratory parameters were analysed.  Results: Anaemia was observed in 78% of children. Microcytic hypochromic anaemia was the predominant peripheral smear pattern (51%), followed by dimorphic anaemia (25%) and macrocytic/megaloblastic anaemia (15%). Low serum iron levels were observed in 81% of participants. Vitamin B12 levels were low in 37% and borderline in 27%, while folate deficiency was present in 9% and borderline folate levels in 34%. Anthropometric parameters did not consistently correlate with haemoglobin, RBC count, or micronutrient levels. Inadequate complementary feeding was reported in 71% of participants. Conclusion: Anaemia and micronutrient abnormalities were common among children with SAM, with low serum iron and suboptimal vitamin B12 and folate status representing important nutritional concerns. The varied haematological patterns suggest multifactorial aetiology. Comprehensive haematological and biochemical assessment, alongside anthropometric evaluation, may facilitate identification of deficiencies and support appropriate nutritional rehabilitation, dietary diversification, and caregiver counselling.

Background: Proximal right coronary artery (RCA) involvement in acute inferior myocardial infarction (MI) is frequently associated with right ventricular (RV) ischemia and dysfunction. Conventional indices of RV systolic function may not detect subtle regional dysfunction. Two-dimensional speckle-tracking echocardiography-derived RV free-wall longitudinal strain (RV-FWLS) provides quantitative assessment of myocardial deformation. Objective: To evaluate the diagnostic utility of RV-FWLS for identifying proximal RCA lesions in patients with acute inferior MI and compare its performance with conventional RV functional parameters. Methods: This cross-sectional observational study included 80 patients with acute inferior MI evaluated between July 2024 and January 2026. RV function was assessed using TAPSE, RV fractional area change (FAC), tricuspid annular systolic velocity (S′), and RV-FWLS. Coronary angiography was used to classify RCA involvement as proximal or distal. Continuous and categorical variables were compared using independent-samples t-test and chi-square test. ROC analysis was used to assess diagnostic performance. Results: Proximal RCA involvement was present in 45/80 patients (56.3%), while 35 (43.7%) had distal RCA lesions. RV-FWLS was significantly less negative in the proximal RCA group than in the distal group (−12.8 ± 4.0% vs −17.6 ± 3.1%; p=0.001). TAPSE and RV FAC did not differ significantly, whereas S′ was lower in the proximal RCA group (11.4 ± 2.3 vs 12.9 ± 2.1 cm/s; p=0.004). An RV-FWLS threshold of ≥−16.0% yielded 81.6% sensitivity, 77.2% specificity and AUC 0.86. The corresponding AUCs for TAPSE, RV FAC and S′ were 0.42, 0.36 and 0.32, respectively. Conclusion: RV-FWLS demonstrated a significant association with proximal RCA involvement and better diagnostic discrimination than the conventional RV parameters evaluated in this cohort. RV-FWLS may be useful as a complementary echocardiographic marker for identifying patients with proximal RCA involvement in acute inferior MI. Prospective multicentre studies with clinical follow-up are required to validate the threshold and establish prognostic utility

Background: Accessory pathway-mediated atrioventricular re-entrant tachycardia (AVRT) represents a significant proportion of paroxysmal supraventricular tachycardia (PSVT) cases. Radiofrequency ablation (RFA) offers excellent outcomes for AVRT, though data from hill populations remain limited. Objectives: To describe the prevalence, clinical presentation, electrophysiological characteristics, and radiofrequency ablation outcomes of AVRT in a Himalayan hill population, and to evaluate the efficacy of 2-Dimensional Electrophysiological study (2D EPS) and RFA in this cohort. Methods: We retrospectively analyzed consecutive patients with PSVT who underwent EPS and RFA between 2019 and 2025 at a single tertiary-care center in a Himalayan state. Demographic variables, accessory pathway characteristics, electrocardiographic and electrophysiological findings, radiofrequency outcomes, and follow-up outcomes were recorded. Results: Among 185 patients with PSVT, 77 (41.6%) had accessory pathway-mediated AVRT, demonstrating a high prevalence of Accessory pathway mediated PSVT in this Himalayan tertiary-care cohort. The AVRT cohort comprised 38 males (49.3%) and 39 females (50.6%), with mean age of 37.5 years. All 77 AVRT patients underwent successful RFA. Acute procedural success was achieved in 98.7% cases with no major complications and 1.3% arrhythmia recurrence during follow-up at 6 and 12 months. Conclusions: Accessory pathway-mediated AVRT represented a substantial (41.6%) and clinically important proportion of PSVT in this Himalayan hill population, with excellent outcomes after catheter ablation. Our findings exceed the prevalence reported in many PSVT cohorts, highlighting the considerable burden of accessory pathway-mediated tachycardia in Sikkim and supporting the feasibility and clinical value of advanced electrophysiology services in resource-limited Himalayan regions.

Background: Objectives The Björk-Shiley tilting-disc mechanical prosthesis represents an important milestone in the evolution of prosthetic heart valves. Although several studies have described intermediate and long-term outcomes, contemporary data documenting functioning Björk-Shiley prostheses beyond 30-40 years are limited and predominantly consist of individual case reports. This study evaluated the exceptionally long-term follow-up of patients with Björk-Shiley prostheses in the aortic and mitral positions. Methods A retrospective single-centre observational review of historical institutional records was conducted. Follow-up duration was calculated from implantation to last documented assessment. Descriptive proportions reaching prespecified follow-up thresholds (20, 25, 30, 35 and 40 years) were calculated for prostheses with adequate dates.  Results The study identified 52 patients with documented Björk-Shiley valve implantation. Björk-Shiley prostheses were present in the aortic position in 26 patients and in the mitral position in 33 patients, with 7 patients having Björk-Shiley prostheses in both positions. Among aortic prostheses, complete dates permitting calculation of follow-up were available for all 26 patients. Mean follow-up was 26.9 years, with a median of 25.6 years and maximum documented follow-up of 40.4 years. Twenty-two patients had ≥20 years, 11 had ≥30 years and 1 had ≥40 years of follow-up. Among the 33 mitral prostheses, complete follow-up dates were available for 30. Mean follow-up was 29. 1 years, median follow-up was 29.7 years and maximum documented follow-up was 43.4 years. Twenty-five patients had ≥20 years, 15 had ≥30 years and 4 had ≥40 years of follow-up. Conclusions Björk–Shiley mechanical prostheses in this historical cohort had documented follow-up extending beyond four decades. A numerically greater proportion of evaluable mitral prostheses reached later follow-up thresholds; these findings do not demonstrate a difference in survival or freedom from valve-related events. Long-term clinical surveillance and anticoagulation remain important.

Background: Objective: Early assessment of myocardial reperfusion after fibrinolytic therapy is essential in patients with ST-segment elevation myocardial infarction (STEMI). The T peak–T end (Tp–e) interval reflects transmural dispersion of ventricular repolarization and may serve as a simple electrocardiographic marker of successful reperfusion. The present study aimed to evaluate the reduction in Tp-e interval post-fibrinolysis as a marker of successful reperfusion in STEMI patients in the Central Indian population.  Methods: This cross-sectional study included 119 consecutive adult STEMI patients (18–80 years) who underwent fibrinolysis within 12 hours of symptom onset. Baseline characteristics, and 12-lead ECG were performed before fibrinolysis. A repeat ECG was obtained 90 minutes after fibrinolysis to assess ST-segment resolution and Tp–e interval. Reduction in Tp–e interval (ΔTp–e) was calculated, and patients were classified as having successful or failed fibrinolysis based on ≥50% ST-segment resolution.  Results: Successful reperfusion was achieved in 76 (63.9%) patients. The median Tp–e interval decreased significantly from 95 (82–110) ms before fibrinolysis to 78 (66–92) ms after fibrinolysis (p<0.001). Patients with successful fibrinolysis showed a greater reduction in Tp–e interval than those with failed fibrinolysis [22 (16–30) ms vs. 8 (4–14) ms; p<0.001]. A ΔTp–e ≥15 ms was independently associated with successful reperfusion (OR: 9.36; 95% CI: 4.02–21.78; p<0.001). ROC analysis demonstrated good diagnostic performance (AUC: 0.84), with 76.3% sensitivity, 74.4% specificity, and 75.6% overall accuracy. Prolonged baseline Tp–e interval and lower ΔTp–e was also significantly associated with ventricular arrhythmias and in-hospital major adverse cardiac events (p<0.001).  Conclusion: Reduction in the Tp–e interval is a simple, non-invasive, and reliable ECG marker of successful fibrinolysis and provides valuable prognostic information for early risk stratification in STEMI patients.

Background: Coronary chronic total occlusions (CTOs) refer to 100% blockages that result in no blood flow (TIMI grade 0) in the affected segment and have lasted for a confirmed or estimated duration of at least three months. Microcatheter overuse can cause fatigue, leading to entrapment or detachment, while balloons and stents are prone to entanglement in calcified or stented areas. This study evaluated the outcomes and feasibility of performing CTO PCI without the use of microcatheters, focusing on guidewire type ,techniques , assessing the impact on procedural success, complications and overall patient outcomes. Method: This retrospective observational study utilized data collected from PNA Shifa Hospital Karachi, including all the adult patients (18 or above) of CTO PIC procedures from 2018 to 2024 performed with and without using microcatheters. Result: The chi-square test applied to the pre-and post-dilation outcomes revealed no statistically significant differences between procedures with or without microcatheters. The p-value was >0.05 indicating that the use of microcatheters had no impact on the success of the dilation and excellent results were achieved in both groups. Conclusion: Microcatheters make the procedure more successful in many CTO-PCI cases, especially in challenging anatomies. This study's findings and supporting literature suggested that alternative strategies can be equally effective in achieving favorable outcomes, depending on the operator's expertise and the specific lesion characteristics.

Background: Over 41 million people live with HIV. With 12% of them still unaware of their status, untreated mental illness in this population leads to non-adherence, higher viral loads, increased immunosuppression, morbidity, mortality, and transmission risk. Methods: It is a cross-sectional study in 100 individuals aged 18-65 years who were diagnosed as HIV positive. Prevalence of depression and other psychiatric comorbidities, were diagnosed with ICD10, and screening and severity of psychotic and affective symptoms assessed with BPRS and HDRS scales.  Results: Prevalence of psychiatric morbidity was 33%, including 12% depressive disorder. Mean duration of HIV illness in those depressed was longer, than those with no psychiatric morbidity, but depression was negatively associated with CD4 count. BPRS scores were found to have a negative correlation with CD4 count and duration of HIV illness.  Conclusion: Persons with HIV need regular screening for early management of psychiatric morbidities. Strategies for good healthcare support system, especially for women, may result in potentially higher QOL outcomes. Facilitating access to care including mental health should be made a priority for this vulnerable population.

Background: Hyponatremia, defined as serum sodium <135 mEq/L, is a frequent electrolyte disturbance in critically ill patients and has been associated with prolonged ICU stay, mechanical ventilation, and increased mortality. This study aimed to determine the prevalence, severity, and etiological profile of hyponatremia in Medicine ICU (MICU) patients and to assess its association with clinical outcomes. Methods: A total of 177 critically ill patients aged 18 years and above admitted to the MICU were enrolled in the study. Serum sodium levels were measured on admission, and hyponatremic patients were categorized by severity (mild, moderate, severe) and volume status (euvolemic, hypovolemic, hypervolemic). Clinical data, comorbidities, treatment details, ventilator requirements, and outcomes were analyzed using standard statistical tests. Results: The mean age of patients was 52.99±12.6 years, with slight male predominance (52.5%). Hyponatremia was present in 63 patients (35.6%), with 18.1% severe, 11.3% moderate, and 6.2% mild cases. Hypervolemic hyponatremia was most common (50.8%), followed by hypovolemic (38.1%) and euvolemic (11.1%). Congestive cardiac failure (25.4%) and chronic kidney disease (20.6%) were leading etiologies. Ventilator support was required in 49.1% of patients, with mean duration of 8.6±2.9 days. Mortality occurred in 21.5% of cases. While the overall presence of hyponatremia was not significantly linked to mortality (p=0.111), increasing severity showed a strong association with adverse outcomes (p=0.048) and prolonged ventilation (p=0.004). Conclusion: Hyponatremia was a common electrolyte disturbance among MICU patients, with severe cases showing higher mortality and prolonged ventilation. Hypervolemic hyponatremia, mainly due to cardiac and renal causes, was most frequent. Early recognition and severity-based management are crucial for improving outcomes in critically ill patients

Background: Hypokalemia associated with hypertension is an important clinical clue to secondary hypertension, particularly primary hyperaldosteronism. Early identification of the underlying cause facilitates targeted treatment and reduces cardiovascular morbidity. The present study was undertaken to evaluate the clinical presentation, laboratory profile, and etiological spectrum of patients presenting with hypokalemia associated with hypertension. Methods: This hospital-based observational cross-sectional study included 80 adult patients with hypertension and serum potassium levels <3.5 mEq/L recruited over 18 months at a tertiary care teaching hospital. Demographic characteristics, clinical features, blood pressure, laboratory investigations, hormonal profile, electrocardiographic findings, and final diagnoses were recorded. Data was analyzed using SPSS version 22.0, with p<0.05 considered statistically significant. Results: The majority of patients were aged 41–60 years (51.3%) with male predominance (57.5%). Fatigue (70.0%), muscle weakness (61.3%), and headache (55.0%) were the most frequent presenting symptoms. Stage 2 hypertension was most common (41; 51.3%) and mild hypokalemia was predominant (39; 48.7%). Mean serum potassium was 2.91±0.42 mEq/L, and 76.3% of patients had spot urine potassium-to-creatinine ratio ≥15 mEq/g. The mean aldosterone-to-renin ratio was elevated (31.6±12.8). U waves were the most common electrocardiographic abnormality (45.0%). Primary hyperaldosteronism was the leading diagnosis (42.5%), followed by renovascular hypertension (22.5%). Patients with primary hyperaldosteronism had significantly higher mean aldosterone–renin ratio (42.8±10.6) than other groups (p<0.001). Conclusion: Hypokalemia in hypertensive patients frequently indicates an underlying secondary cause, particularly primary hyperaldosteronism, and may be associated with significant target-organ damage. Early clinical, biochemical, hormonal, and ECG evaluation is essential for timely diagnosis and prevention of cardiovascular and renal complications.