Introduction Patients with COVID‐19 are known to have a coagulopathy with a thrombosis risk. It is unknown whether this is due to a generalized humoral prothrombotic state or endothelial factors such as inflammation and dysfunction. The aim was to further characterize thrombin generation using a novel analyser (ST Genesia, Diagnostica Stago, Asnières, France) and a panel of haematological analytes in patients with COVID‐19. Methods Platelet poor plasma of 34 patients with noncritical COVID‐19 was compared with 75 patients with critical COVID‐19 (as defined by WHO criteria) in a retrospective study by calibrated automated thrombography and ELISA. Patients were matched for baseline characteristics of age and gender. Results Critical patients had significantly increased fibrinogen, CRP, interleukin‐6 and D‐dimer compared to noncritical patients. Thrombin generation, in critical patients, was right shifted without significant differences in peak, velocity index or endogenous thrombin potential. Tissue plasminogen activator (tPA), tissue factor pathway inhibitor (TFPI) and vascular endothelial growth factor (VEGF) were significantly increased in the critical versus noncritical patients. Critically ill patients were on haemodiafiltration (31%; heparin used in the circuit) or often received escalated prophylactic low‐molecular weight heparin. Conclusion These results confirm increased fibrinogen and D‐dimer in critical COVID‐19‐infected patients. Importantly, disease severity did not increase thrombin generation (including thrombin‐antithrombin complexes and prothrombin fragment 1 + 2) when comparing both cohorts; counter‐intuitively critical patients were hypocoaguable. tPA, TFPI and VEGF were increased in critical patients, which are hypothesized to reflect endothelial dysfunction and/or contribution of heparin (which may cause endothelial TFPI/tPA release).

Background: Tuberculosis is the most common presenting illness among people living with HIV, including those who are taking anti-retroviral treatment. There were an estimated 1.2 million HIV positive new TB cases globally in 2014. Around 74% of these infected people live in sub-Saharan Africa. Aim and objectives were to study the treatment outcome of tuberculosis among HIV co-infected patients; to assess the outcome of TB treatment in TB patients with respect to their HIV status and to study the underlying factors influencing the outcome rates. Methods: A descriptive cross-sectional study was designed and conducted in Municipal Corporation area, Aurangabad. For this study, HIV co-infected patients registered at city Tuberculosis Centre, Aurangabad were noted and thus information only on TB-HIV status of patients was collected. Results: In this study majority of the study participants were in the age group between 35 and 49 years (45.98%); which is in the reproductive age group. HIV-TB co-infected in this region was mostly males (60.92%). Conclusions: Important conclusion of the study is that very few patients got cured off TB among TB-HIV co-infected patients. One of the reasons could be immunosuppression of HIV patients make them vulnerable for getting active TB and its rapid progression. All the rates i.e. death, default & transfer rate are all above the standard rate i.e. 5% as per RNTCP guidelines.

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Background: This particular study was conducted in rural area of deep interiors of Marathwada with the objective to find prevalence of type ii diabetes mellitus and to understand the interrelationship of diabetes mellitus and the other associated risk factors in the area with the particular focus on people staying in the area.Methods: This was a cross sectional study conducted in selected rural area of revenue circle Pishor and Nachanwel of selected Kannad tehesil covering 6 Villages with approximate households of 5000. The study was done in adults greater than 20 years of age. Only one member from each household was included for the study, using simple random sampling by lottery method from each of the family till we cover 20% of the households as a sample from each of the village to get a total of 1000 which is more than calculated sample size i.e. 900. Results: The prevalence of diabetes in the study area was 11.2% while that of pre diabetes was 6.6%. Prevalence in males was 12.8% while that in females was 9.02%. The risk Factors associated with diabetes in this study on univariate analysis were gender (male), age (increasing age), type of occupation, education, higher socioeconomic class, family H/O Diabetes, whereas on multivariate analysis age, occupation, socioeconomic class, were found to be significantly associated. Conclusions: Prevalence of 11.2% is large; it does give a warning signal of upcoming epidemic of diabetes all over India. High risk strategies should be adopted for screening of diabetes at the level of primary health centre to detect people with diabetes and impaired glucose tolerance at earliest possible time. ‘Primary Health Care’ approach with focus on the common risk factors is needed even in remote rural areas.

Background: Heart disease is the leading cause of mortality in population above the age of 65 years. Severity and prevalence of coronary artery disease (CAD) increase with increasing age. Thrombolysis remains the standard of care in the management of acute ST-elevation myocardial infarction (STEMI) in developing countries like India where primary percutaneous coronary intervention (PCI) is still not possible in the majority of patients. The risks and benefits of thrombolytic reperfusion therapy among the elderly patients with STEMI is much less known. Authors aimed to evaluate the outcome and complications of thrombolytic therapy in elderly patients admitted with acute STEMI.Methods: The present observational study was done between January 2017 and January 2019 in the department of cardiology, Dr. S.N. Medical College, Jodhpur, India. It included a study group comprising 102 consecutive elderly patients who had acute STEMI and underwent thrombolytic therapy and a control group comprising 102 consecutive elderly patients who had STEMI who were not given thrombolytic therapy. Both groups were evaluated for an outcome (in-hospital mortality) and complications.Results: The overall in-hospital mortality was less in thrombolytic therapy group as compared to control group although not statistically significant (8.82% versus 14.70%, p=0.277). Similarly, in-hospital mortality was less in thrombolytic therapy subgroup A (age 66-74 years) as compared to control subgroup A (6.45% versus 10.75%, p=0.583) and also less in thrombolytic therapy subgroup B (age 75-85years) as compared to control subgroup B (12.50% versus 21.62%, p=0.445).  Among the traditional risk factors, co-morbid conditions and complications, there was less prevalence of diabetes mellitus (4.90% versus 15.68%, p=0.021), hypertension (5.88% versus 6.86%, p=1.000), cardiogenic shock (8.82% versus 9.80%, p=1.000), left ventricular failure (LVF) (0.98% versus 3.92%, p=0.365) and atrioventricular (AV) block (0% versus 4.90%, p=0.245) but more acute kidney injury (AKI) (2.94% versus 0%, p=0.070) in thrombolytic therapy group patients as compared to control group patients.  Cerebrovascular accident (CVA) did not occur in both group patients.Conclusion: Despite the higher prevalence of co-morbidities and high risk features in elderly patients of acute STEMI, timely thrombolysis is beneficial. A mortality benefit was seen in all groups suggesting net benefit regardless of increasing age up to the age of 85 years.

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Background: Routinely, two-dimensional (2D) left ventricular ejection fraction (LVEF) is used to assess the left ventricular (LV) systolic function. Lately, global longitudinal peak systolic strain (GLPSS) has emerged to be a more sensitive tool for assessing LV systolic function. We aimed to assess the superiority of GLPSS by 2D speckle-tracking echocardiography in patients with ST-elevation myocardial infarction (STEMI) before and within 48 h after percutaneous coronary intervention (PCI) over 2D-LVEF calculated using the Simpson's biplane method of disks. Materials and Methods: A total of 70 patients with STEMI who underwent PCI were included in this study, which was conducted in the Department of Cardiology, MDM hospital, Jodhpur, Rajasthan, India, between November 2018 and February 2019. Patients having preexisting cardiomyopathy, moderate-to-severe valvular heart disease, morbid obesity, and poor echocardiographic window were excluded from the study. Echocardiography before and within 48 h of PCI was done. 2D-LVEF was calculated using Simpson's method. GLPSS was assessed using the automated function imaging technique. Results: Post-PCI GLPSS increased significantly compared to pre-PCI value (−17.68 vs. −16.65;P < 0.002). 2D-LVEF, on the contrary, did not show any significant increase post-PCI (40.1 vs. 40.57;P = 0.98). Furthermore, the improvement in the average GLPSS was significantly higher when the target vessel revascularized was nonleft anterior descending (LAD) than LAD (−18.32 vs. −17.46;P < 0.001) . Conclusion: The assessment of LV systolic function after PCI in patients with STEMI was superior with GLPSS when compared to 2D LVEF. As strain imaging is an inexpensive tool, it can be applied easily to assess LV function in the large subset of population.