Background: Extracorporeal shock wave lithotripsy (ESWL) is an effective non-invasive method for managing urinary tract calculi. Present study was undertaken to evaluate factors that may influence ESWL clinical outcomes in Indian patients with urinary tract calculi.Methods: This prospective study was conducted at Department of Urology, Medical Trust Hospital Cochin, India in the period from September 2006 to March 2009. Sixty patients with upper urinary tract lithiasis having stone size between 5 to 25 mm were included and patients with ˃2 calculi, distal ureteric obstruction (not relieved), renal anomalies were excluded. All patients were treated with DIREX medical system lithotripter. Clinical outcome of ESWL was assessed by factors like site, size, density and skin-to-stone distance. After statistical analysis, p-value ≤0.05 was taken as the level of significance.Results: The overall success of ESWL was 82%. The final success of ESWL for sites like ureter, pelvis, mid or upper and lower calyx were 94.1%, 84%, 85.7% and 58% respectively (p = 0.095). The rate of fragmentation of stone after one session of ESWL for stone size ≤10 mm, 11 mm - 20 mm and ≥21 mm was 76.5%, 68.4% and 16.7% respectively (p=0.009). For stone density 751-1000 HU, 22.2% patients required ≥2 sessions to achieve stone free status (p<0.0005). Around 15.6% patients in skin-to-stone distance (SSD) ≤10cm required ≥2 sessions to achieve stone free status (p = 0.27).Conclusions: ESWL should be considered a primary modality of treatment in patients with calculi size ≤20 mm, density ≤ 1000 HU, pelvic, ureteric and upper and/or middle calyceal calculi and for SSD ≤10 cm.

Background: Patients with hypertension in India been reported with high heart rate owing to Sympathetic overdrive (SO). Beta-blockers provides several positive effects to reduce SO in patients with hypertension. The aim of the study was to understand current real-world prevalence of SO in Indian patients with hypertension and usage of beta-blocker therapy in them.Methods: A cross sectional, observational, questionnaire-based survey conducted across India between June 2020 to October 2020. A specially designed validated questionnaire was shared with 157 registered Health care practitioners (HCP) and their anonymous inputs were captured and analysed in qualitative manner. Categorical data was summarized by number (n) and percentage (%).  Results: Total 157 HCP participated and completed the survey. Around 53% of HCP observed that patients with average heart rate above 75 beats/min were associated with negative prognosis. Around 43% of HCP reported that raised heart rate is associated with advance age and increased Body mass index (BMI). Two-third of HCP reported that tachycardia is associated with stage-2 hypertension and marked by restlessness and anxiety which is suggestive of SO. Over 70% HCP agreed that the HR below 75 beats/min is associated with good prognosis. Around 89% HCP reported beta-blockers as the drug of choice in patients with augmented SO. S-metoprolol was reported to be most preferred beta-blocker agent and recommended by 76% HCP in patients with hypertension and coexisting SO.Conclusions: SO been reported prevalent in Indian patients with hypertension which likely worsen the prognosis in these patients. Beta-blockers reported to be the preferred choice of anti-hypertensive and S-metoprolol seem to be the most preferred agent amongst the available beta-blockers against SO in patients with hypertension in India.

The development of hypertension and heart failure is correlated with the hyperactivation of the sympathetic nervous system. Beta-blockers are often considered a good therapeutic option in such clinical scenarios. However, the choice of β-blocker is a concern because of certain aspects like associated metabolic disturbances with their usage. Metoprolol has been reported to have the potential to alleviate sympathetic overdrive in patients with hypertension and heart failure. S-Metoprolol is the chirally pure β-blocker with favorable pharmacological features, improved safety profile, and allied clinical advantages versus racemic metoprolol; given this, can it be an effective therapeutic option against sympathetic overdrive in patients with hypertension and/or heart failure is not fully recognized yet. In this review, we attempted to discuss the current facts around sympathetic overdrive linked with hypertension as well as heart failure and pertaining pharmacological intervention with a focus on β-blockers in these clinical situations with an emphasis on the likely beneficial role of S-metoprolol.

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