This podcast discusses the diagnosis and management of acute coronary syndrome (ACS) in resource-limited settings, focusing on the evolving understanding of symptoms, the role of ECG and troponin testing, and the importance of clinical examination and scoring systems for effective triage. It highlights the atypical presentations in women and the challenges faced in rural healthcare settings. This conversation delves into the management of acute coronary syndromes, focusing on thrombolysis for ST elevation myocardial infarction, the treatment of non-ST elevation myocardial infarction, the role of angioplasty in stable angina, and the essential post-discharge care for patients. The discussion emphasizes the importance of timely intervention, effective communication among healthcare providers, and the need for comprehensive follow-up care to ensure optimal patient outcomes.Summary- Indians often present with younger age for myocardial infarction.- Classical symptoms of ACS are changing; atypical presentations are common.- ECG findings are crucial for diagnosing ACS, especially ST changes.- Troponin testing has evolved to improve diagnosis accuracy.- Scoring systems like TIMI and HEART are essential for triaging patients.- Women often present with atypical symptoms and are underdiagnosed.- Point of care tests can enhance diagnostic capabilities in rural settings.- Clinical examination remains vital in assessing chest pain.- Understanding likelihood ratios can aid in better diagnosis of ACS.- Resource constraints significantly impact the management of ACS. Thrombolysis is crucial for ST elevation myocardial infarction.- Early intervention significantly improves patient outcomes.- WhatsApp is a valuable tool for sharing ECGs and medical information.- Non-ST elevation myocardial infarction requires different management than STEMI.- Stable angina can often be managed effectively with medication rather than angioplasty.Resources:Dr.Jamshed Dalal: https://www.kokilabenhospital.com/professionals/jamsheddalal.htmlDr. Dr. Chaitanya H Balakrishnan : https://www.stjohns.in/medicalcollege/Medicine_ChaitanyaHBalakrishnan.phpDr.Shitij Arora: https://einsteinmed.edu/faculty/14156/shitij-aroraChapters00:00 Understanding Acute Coronary Syndrome Presentation03:05 The Role of ECG in Diagnosis03:12 How do you recognize an Acute Coronary Syndrome?04:18 How has the presentation of acute coronary syndrome changed?05:57 Clinical Examination and Risk Assessment07:02 Are there any clinical features which may point towards high chances of an acute coronary syndrome?08:49 What ECG characteristics point towards ACS or otherwise?08:59 Scoring Systems for Triage11:15 What are the validated risk scoring systems to help guide triage?11:53 The Evolution of Troponin Testing14:58 Challenges in Resource-Limited Settings16:55 What should our approach to diagnosis be; when you have troponins and when you don't have troponins?17:49 Atypical Presentations in Women20:56 Summary and Key Takeaways23:00 Why are women subjected to less testing and remain underdiagnosed?25:22 Summary of Part A29.39 How do you manage STEMI ?36:07 Thrombolysis in Acute Myocardial Infarction42.50 What does a successful thrombolysis look like? What should we do if it’s not?44:00 A model that can be adopted nationally47:15 Is there any role of Echocardiogram in an acuteMI?49:00 Difference in the management of non-ST elevation MI compared to STEMI53:50 Type 1 and Type 2 MI54:56 Acute coronary syndrome presents with unstable hemodynamic58:36 Management of unstable angina vs Non-STEMI?01:01:11 Does angioplasty have any value in stable angina in the modern medical therapy era?01:07:26 Criteria for discharge, post discharge care and monitoring48:27 Management of Non-ST Elevation Myocardial Infarction01:00:22 Stable Angina and the Role of Angioplasty01:07:11 Post-Discharge Care for Acute Coronary Syndrome Patients

In this episode of the CSA Podcast, we delve into the critical topic of acute undifferentiated febrile illness (AUFI) and its management in under-resourced settings. Join Dr. Shiva Kumar Narayanan, and Dr. Gajanan Phutke explore the complexities surrounding the diagnosis and treatment of febrile illnesses, particularly in the context of India. We begin by discussing the significance of AUFI, which is characterized by fever lasting from three to 21 days without clear localizing symptoms. This condition poses a major challenge in India, where infectious diseases are a leading cause of morbidity and mortality. We highlight the prevalence of febrile episodes in adults, particularly in rural areas, and the common causes, including malaria, dengue, enteric fever, and other viral infections. To illustrate our discussion, we present two case scenarios: a 35-year-old farm worker from rural West Bengal with high-grade fever and a 28-year-old pregnant woman from Mumbai with fever and myalgias. These cases serve as a framework for understanding the diagnostic pathways and treatment options available to healthcare providers in resource-limited settings. Dr. Gajanan Phutke and Dr. Shiva Kumar Narayanan, emphasize the importance of thorough history-taking and physical examination in diagnosing AUFI. We discuss the various signs and symptoms that can guide clinicians in narrowing down their differential diagnoses. Additionally, we address the limitations of diagnostic tests available in these settings, including rapid diagnostic tests for malaria and dengue, and the challenges posed by serological tests for leptospirosis and scrub typhus. As we navigate through the complexities of AUFI, we stress the need for judicious use of resources. We recommend initial investigations such as complete blood counts and renal panels, while also considering the clinical context to determine the necessity of further testing. The discussion also touches on the importance of empirical treatment, particularly in cases where diagnostic resources are limited. Throughout the episode, we highlight the need for a tailored approach to managing febrile illnesses, taking into account the geographical and seasonal variations in disease prevalence. We conclude by reiterating the significance of community-based healthcare and the role of clinicians in providing evidence-based care in resource-poor settings. Join us for this informative episode as we equip healthcare providers with the knowledge and tools necessary to effectively manage acute undifferentiated febrile illness in their communities. Host: Dr. Shiva Kumar Narayanan https://www.medschool.umaryland.edu/profiles/narayanan-shivakumar// Guest: Dr. Gajanan Phutke https://healinitiative.org/team-showcase/gajanan-phutke/ Community Science Alliance Website: https://communitysciencealliance.org/ X: https://x.com/csa_scienceall Chapters: 00:00:00 - Introduction to Acute Undifferentiated Febrile Illness 00:01:10 - Overview of the CSA Podcast and Its Purpose 00:01:22 - Case Scenarios Introduction 00:02:06 - Case Scenario 1: Farm Worker with Fever 00:02:39 - Case Scenario 2: Pregnant Woman with Fever 00:03:22 - Introduction of Hosts and Their Backgrounds 00:04:15 - Understanding Acute Undifferentiated Fever 00:04:40 - Significance of Acute Undifferentiated Fever in India 00:09:14 - Common Causes of Acute Undifferentiated Fever in India 00:14:31 - Epidemiology of Febrile Illnesses 00:15:05 - Approach to Diagnosis in Resource-Limited Settings 00:19:10 - Importance of Detailed History and Physical Examination 00:23:02 - Physical Exam Signs in Febrile Illness 00:24:06 - Initial Workup for Undifferentiated Fever 00:27:26 - Challenges with Rapid Diagnostic Tests 00:30:22 - Specific Diagnostic Tests for Common Illnesses 00:36:05 - Limitations of Serologic Tests 00:41:04 - Management Approaches for Acute Undifferentiated Fever 00:44:11 - Supportive Care and Symptomatic Treatment

In this episode of the CSA podcast, Dr. Rajani Bhat and Dr. Pavitra Mohan discusses Community Acquired Pneumonia (CAP) and its challenges in resource-constrained settings. They emphasize the need for a thorough clinical examination in the of context of diagnosing and treating CAP. The conversation covers diagnostic challenges, antibiotic choices, the role of steroids, treatment duration, and the significance of antimicrobial stewardship. Dr. Mohan also highlights the difficulties of managing CAP in rural areas, particularly the need for access to radiology and microbiology resources. The episode ends with practical tips for young practitioners, focusing on advancing contextually relevant evidence-based medicine (EBM) in resource-constrained settings. Takeaways: "-Context is crucial in diagnosing and treating community-acquired pneumonia (CAP) in resource-constrained settings. -A thorough clinical examination is essential in the absence of easy access to radiology and lab testing. -Antibiotic choices should be based on the patient's stability, comorbidities, and local epidemiology. -Steroids have limited role in primary care settings for CAP, except in cases of acute exacerbation of chronic lung diseases. -The duration of antibiotic treatment for CAP is typically 5-7 days, with close monitoring and follow-up. -Vaccinations, such as influenza and pneumococcal vaccines, are important but face challenges in terms of cost and awareness. -Antimicrobial stewardship is crucial in preventing the development of antimicrobial resistance. -Young practitioners should focus on evidence-based guidelines, standardized protocols, and developing clinical acumen. -Access to radiology and microbiology resources is a challenge in managing CAP in resource-constrained settings. -The balance between referral and managing patients in primary care settings is important, considering the patient's context and resources available." Host: Dr. Rajani Bhat Linkedin: https://www.linkedin.com/in/rajani-surendar-bhat-9057891a5/ X: https://x.com/rajanisurendarb/ Guest: Dr. Pavitra Mohan Linkedin: https://www.linkedin.com/in/pavitra-mohan-72bb831b/ Community Science Alliance Website: https://communitysciencealliance.org/ X: https://x.com/csa_scienceall Podcast: https://omny.fm/shows/communitysciencealliance/playlists/podcast Watch this episode here: youtube.com/@communitysciencealliance Chapters: 00:00 Introduction to Community Science Alliance and Basic Health Services 02:21 Challenges and Context in Diagnosing and Treating Community-Acquired Pneumonia 04:40 The Role of Clinical Examination in the Absence of Radiology and Lab Testing 13:16 Choosing the Right Antibiotics for Community-Acquired Pneumonia 25:09 Duration of Antibiotic Treatment and the Importance of Monitoring 30:58 Vaccinations and Antimicrobial Stewardship 36:14 Practical Pointers for Young Practitioners in Managing CAP 39:10 The Need for Access to Radiology and Microbiology Resources 44:56 Balancing Referral and Managing Patients in Primary Care Settings