Background Routine viral-load (VL) measurements along with enhanced adherence counselling (EAC) are recommended to achieve virological suppression among people living with HIV/AIDS (PLHA) on anti-retroviral therapy (ART). The Mumbai Districts AIDS Control Society along with Mé decins Sans Frontières has provided routine VL measurements and EAC to PLHA on ART at King Edward Memorial (KEM) hospital, Mumbai since October-2016. This study aims to describe the initial VL results and impact of EAC on viral suppression and factors associated with initial viral non-suppression among patients with an initial detectable VL, in a cohort of patients tested between October-2016 and September-2018. Methods This is a descriptive study of PLHA on ART who received VL testing and EAC during October-2016 to September-2018. Log-binomial regression was used to identify factors associated with a high VL. Results Among 3849 PLHA who underwent VL testing, 1603(42%) were female and median age was 42 years (IQR:35-48). Majority were referred for routine testing (3432(89%)) and clinical/immunological failure (233(6%)). Overall, 3402(88%) PLHA had suppressed VL at initial testing. Among 3432 tested for routine monitoring, 3141(92%) had VL suppressed. Of 291 with VL>1000c/ml, 253(87%) received EAC and after repeat VL, 70(28%) had VL<1000c/ ml. Among 233 referred for clinical/immunological failure, 122(52%) had VL>1000c/ml and 109 have been switched to second-line ART. CD4 count<500 (aOR-5.0[95%CI 3.8-6.5]), on ART for<5 years (aOR-1.5[1.1-2.0]) and age<15 years (aOR-5.2[3.0-8.9]) were associated with an initial VL>1000c/ml. Factors
To evaluate the compliance of the elderly with cardiac rehabilitation (CR) after myocardial infarction, 370 consecutive patients greater than or equal to 65 years of age, admitted to our Coronary Care Unit over a period of 2 years, were examined: 48 died in the hospital, 34 were transferred to other wards and 29 were unable to perform a submaximal exercise test before discharge. Out of the remaining 259 patients, 43 began the CR and 32 completed it with a good outcome. Eleven patients interrupted the CR because of associated diseases. A social investigation was carried out on 83 of the 259 patients discharged from our ward. In addition to associated diseases and an extremely low exercise tolerance (41% of cases), the lack of participation was due to socioeconomic problems (9.5%), to lack of motivation (52.3%) and to inadequate information (38.1%). Nevertheless, 76% of patients indicated that they attained their previous way of life in a relatively short period of time. It is concluded that: CR is useful in patients who complete it; low compliance is due mainly to medical problems and lack of motivation; better information might slightly increase the compliance in our Center; most patients can, in any case, reach their previous way of life. It is debatable whether CR is advisable in old age, or should be directed towards selected groups of patients.
Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564
Objectives: Chronic renal failure (CRF) is a public health concern in both developed and developing countries. Therefore, there is still a need to look for secure and successful agents that can either minimise or prevent CRF from advancing to end-stage renal disorder. This study aimed to assess the effect of lycopene on adenine-induced CRF in the rat. Materials and Methods: Animals were divided into five groups (n = 6). Normal control group received normal vehicle, disease control group received orally adenine (50 mg/kg/day), L 100 group received orally lycopene (100 mg/kg/day) + adenine (50 mg/kg/day), L 200 group received orally lycopene (200 mg/kg/day) + adenine (50 mg/kg/day) and L 400 group received orally lycopene (400 mg/kg/day) + adenine (50 mg/kg/day) for 30 days. Results: Compared to the control group, the disease control group had decreased bodyweight, food intake and also increased the relative kidney weight and urine output. Adenine-treated group also significantly increased the blood urea nitrogen, serum creatinine, phosphorus, alkaline phosphatase, uric acid, magnesium and reduced the calcium, urine creatinine and urine urea nitrogen. Besides, adenine also gave a positive test of serum C-reactive protein and proteinuria. Histopathologically, adenine caused significant inflammatory changes to renal tissues compared with the normal control group. When administered concomitantly with adenine, lycopene alleviated all the measured adenine-induced physiological, biochemical and histological changes. Conclusion: We concluded from this analysis that oral lycopene administration could potentially mitigate the adverse effect of CRF that might be due to their antioxidant and free radical scavenging properties.
To determine the antiarrhythmic efficacy of beta-blockers (beta-B) and verapamil (V) in exercise-induced ventricular tachycardia (Ex-VT), nine patients with reproducible Ex-VT (in two consecutive exercise tests) were studied by means of electrophysiologic study (EPS) in basal conditions and serial exercise testing after beta-B (metoprolol 25 mg tid to 100 mg qid; oxprenolol 40 mg tid) and/or V (80-160 mg tid). Ejection fraction was normal in four cases and depressed in five. Of these nine patients, four developed Ex-VT during chronic amiodarone treatment, which was continued. During EPS, VT was induced at a critical atrial pacing rate in one case, and with the extrastimulus technique in four. Ventricular tachycardia was not inducible with either technique in four patients. Five of the six patients on beta-B and none of the seven on V developed Ex-VT, although they achieved the same or higher work-loads as compared to the basal exercise tests. In the case with rate-dependent VT, beta-B and V prevented VT at work-loads, sinus rates and double products significantly higher than those obtained in basal conditions. In the others, maximal heart rate and double product were lower on beta-B and showed a wide variability on V. V and beta-B appeared to be highly effective in preventing Ex-VT, in patients with normal heart as well as in those with greatly depressed ejection fraction. Both of the drugs appeared to suppress re-entry or triggered activity in the patient with rate-dependent Ex-VT.(ABSTRACT TRUNCATED AT 250 WORDS)
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