Background —The clinical spectrum of constrictive pericarditis (CP) has been affected by a change in incidence of etiological factors. We sought to determine the impact of these changes on the outcome of pericardiectomy. Methods and Results —The contemporary spectrum of CP in 135 patients (76% male) evaluated at the Mayo Clinic from 1985 to 1995 was compared with that of a historic cohort. Notable trends were an increasing frequency of CP due to cardiac surgery and mediastinal radiation and presentation in older patients (median age, 61 versus 45 years). Perioperative mortality decreased (6% versus 14%, P =0.011), but late survival was inferior to that of an age- and sex-matched US population (57±8% at 10 years). The long-term outcome was predicted independently by 3 variables in stepwise logistic regression analyses: (1) age, (2) NYHA class, and most powerfully, (3) a postradiation cause. Of 90 late survivors in whom functional class could be determined, functional status had improved markedly (2.6±0.7 at baseline versus 1.5±0.8 at latest follow-up [ P Conclusions —The evolving profile of CP, with increasingly older patients and those with radiation-induced disease in the past decade, significantly affects postoperative prognosis. Long-term results of pericardiectomy are disappointing for some patient groups, especially those with radiation-induced CP. By contrast, surgery alleviates or improves symptoms in the majority of late survivors.

Constrictive Pericarditis in the Modern Era Evolving Clinical Spectrum and Impact on Outcome After Pericardiectomy

Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy.

Constrictive pericarditis: clinical and pathophysiologic characteristics.

In contrast to common belief, pericardial calcification was noted to be a frequent finding in patients with constrictive pericarditis. It is often associated with idiopathic disease and other marke...

Calcific Constrictive Pericarditis: Is It Still with Us?

A modern approach to tuberculous pericarditis.

The medical records of 118 patients (86 male, 32 female, age 10-50 (mean 27) years) who underwent pericardiectomy for constrictive pericarditis at the Christian Medical College Hospital, Vellore, from 1954 to 1985 were reviewed. All had appreciable pericardial constriction. Preoperatively 97 of the 118 were in class III or IV of the New York Heart Association classification and 100 had peripheral oedema or ascites. Tuberculosis was proved as the cause in 72 patients. Pericardiectomy was accomplished through a standard anterolateral thoracotomy (107 cases), median sternotomy (3 cases), or bilateral thoracotomy (8 cases). Postoperatively an apparent low cardiac output state was seen in 34 patients, 12 of whom died. Hospital mortality in the last 12 years was 11%. Mortality was higher in NYHA class III and IV patients. The improved surgical results recently may be related to increased use of inotropic support and prolonged ventilation. At follow up there were 72 patients in whom functional capacity could be assessed; 63 were in class I or II. The poor results of pericardiectomy in some patients are likely to be related to advanced preoperative disability and early pericardiectomy is therefore recommended.

https://thorax.bmj.com/content/thoraxjnl/43/8/637.full.pdf

Early and late results of pericardiectomy in 118 cases of constrictive pericarditis.

The chemistry of nitrogen-containing heterocyclic compound pyrrole and pyrrolidine has been a versatile field of study for a long time for its diverse biological and medicinal importance. Biomolecules such as chlorophyll, hemoglobin, myoglobin, and cytochrome are naturally occurring metal complexes of pyrrole. These metal complexes play a vital role in a living system like photosynthesis, oxygen carrier, as well storage, and redox cycling reactions. Apart from this, many medicinal drugs are derived from either pyrrole, pyrrolidine, or by its fused analogs. This review mainly focuses on the therapeutic potential of pyrrole, pyrrolidine, and its fused analogs, more specifically anticancer, anti-inflammatory, antiviral, and antituberculosis. Further, this review summarizes more recent reports on the pyrrole, pyrrolidine analogs, and their biological potential. 

/pdf/therapeutic-potential-of-pyrrole-and-pyrrolidine-analogs-an-252o3fv2.pdf

Therapeutic potential of pyrrole and pyrrolidine analogs: an update

Naphtho[2,1-b]furan derived triazole-pyrimidines as Highly potential InhA and Cytochrome c peroxidase inhibitors: Synthesis, DFT calculations, Drug-Likeness profile, molecular docking and dynamic studies

This study aims at evaluating the validity profile of Titmus vision screener V4 for gauging visual acuity and colour perception as a screening tool. Eleven hundred young adults attending eye OPD at a tertiary care center were included in the study. All individuals underwent distance visual acuity (DVA) measurement with Snellen chart and Titmus vision screener V4, at 6 m on the same day. Later, these individuals underwent colour vision testing with Ishihara pseudo isochromatic plates and Titmus vision screener V4. The age distribution ranged from 19 to 53 years with mean age as 26.6 years. Males (87.4%) were more as compared to females. Mean DVA measured by Snellen's chart and Titmus vision screener V4 were 0.088 ± 0.15 and 0.110 ± 0.17, respectively (p = 0.000). Mean difference between DVA by Snellen's chart and Titmus screener V4 was −0.021 ± 0.82 with 95% CI (−0.026 to −0.016). For measuring visual acuity, Titmus vision screener V4 showed a sensitivity of 99.5% and specificity of 90.6%. Negative predictive value and positive predictive value were 99.6% and 85.6%, respectively. For diagnosing colour perception, the Titmus vision screener V4 showed a sensitivity of 100% and specificity of 99.8%. The negative predictive value and positive predictive value were 100% and 88.8% respectively. Area under the curve of receiver operating characteristic (ROC) curve was 0.960 with 95%CI (0.949–0.972). Our study supports use of Titmus vision screener V4 as an excellent screening tool for measurement of visual acuity as well as colour perception. 

Validation of Titmus vision screener V4 for diagnosing refractory errors and colour blindness: An analogy with quotidian

Themedical records of118patients (86male, 32female, age10-50 (mean 27)years) who underwent pericardiectomy forconstrictive pericarditis attheChristian Medical College Hospital, Vellore, from1954to 1985were reviewed. Allhadappreciable pericardial constriction. Preoperatively 97ofthe118 wereinclass III orIVoftheNewYorkHeart Association classification and100hadperipheral oedema orascites. Tuberculosis was proved asthecausein72patients. Pericardiectomy was accomplished through a standard anterolateral thoracotomy (107cases), median sternotomy (3cases), orbilateral thoracotomy (8cases). Postoperatively an apparent low cardiac output state wasseenin34patients, 12ofwhomdied. Hospital mortality inthelast 12years was 11%.Mortality washigher inNYHA class IIIandIVpatients. Theimproved surgical results recently may berelated toincreased useofinotropic support andprolonged ventilation. Atfollow up there were72patients inwhomfunctional capacity could beassessed; 63wereinclass IorII. Thepoor results ofpericardiectomy insomepatients arelikely toberelated toadvanced preoperative disability andearly pericardiectomy istherefore recommended.

K Shyamsunder

Papers

Early and late results of pericardiectomy in 118 cases of constrictive pericarditis.

Therapeutic potential of pyrrole and pyrrolidine analogs: an update

Naphtho[2,1-b]furan derived triazole-pyrimidines as Highly potential InhA and Cytochrome c peroxidase inhibitors: Synthesis, DFT calculations, Drug-Likeness profile, molecular docking and dynamic studies

Validation of Titmus vision screener V4 for diagnosing refractory errors and colour blindness: An analogy with quotidian

Early andlate results ofpericardiectomy in118cases ofconstrictive pericarditis