Background The epidemiology of HF in India is largely unexplored. Current resources are based on a few hospital-based and a community-based registry from North India. Thus, we present the data from a single hospital-based registry in South India. Patients admitted with acute heart failure over a period of 1 year were enrolled in the registry and were characterized based on their ejection fraction (EF) measured by echocardiogram. The clinical profile of the patients was assessed, including their in-hospital outcomes. One-way ANOVA and univariate analysis were performed for comparison between three EF-based groups and for the assessment of in-hospital outcomes. Results A total of 449 patients were enrolled in the registry, of which 296, 90, and 63 patients were categorized as, HFrEF, HFmrEF, and HFpEF, respectively. The prevalence of HFrEF was higher (65.99%). The mean age (SD) of the study cohort was 59.9±13.3. The majority of the patients presented with acute denovo HF (67%) and were more likely to be males (65.9%). The majority of patients presented with warm and wet clinical phenotype (86.4%). In hospital mortality was higher in HFmrEF (3.3%). Conclusion Patients with HFrEF had high adherence to guideline-directed medical therapy (GDMT). HFrEF patients were also likely to have longer hospital stay along with a worsening of renal function. The in-hospital mortality was comparable between the EF-based groups. Additionally, the association of clinical phenotypes with outcome highlighted that patients in warm and wet phenotype had a longer length of hospital stay, whereas the mortality and worsening renal function rates were found to be significantly higher in the cold and wet group.
This study was aimed to find out the differences in the pregnancy outcome of PIH women treated with the antihypertensive drugs methyldopa and nifedipine. The prospective observational study was conducted in a multi specialty hospital at Coimbatore with 161 PIH diagnosed women. Women were categorised into the no-drug group, methyldopa group, nifedipine group and methyldopa with nifedipine group. All the women were monitored from diagnosis to delivery. The maternal and neonatal data were collected and analysed. The drugs were significantly controlled the blood pressure (BP) from base to end (P<0.001). There was no significant difference in the reduction of BP between the drugs. Cesarean delivery (>90%) and preterm delivery were high across all the groups. No significant difference was seen between these groups. The AGA (Average for gestational age) babies were significantly higher with a no-drug group (83%) and lower with nifedipine group (40%). Two women were reported with HELLP syndrome in methyldopa with nifedipine group. No significant difference was found in terms of pregnancy outcome between these groups except for eclampsia and AGA. Eclampsia was affected more with 14% in methyldopa with nifedipine group. We found similar outcomes; there were no significant changes between methyldopa, nifedipine, and the no-drug treatment. The antihypertensive drugs nifedipine and methyldopa both were significantly reduced the BP. The maternal and neonatal complications were similar between these two drugs. No beneficial effect can be identified one over another. Pregnancy-induced hypertension (PIH) is associated with the various problems in pregnancy outcome. The complications of high blood pressure (BP) during pregnancy are detrimental [1]. The elevated or uncontrolled BP leads to early and cesarean delivery also caused various complications to both mother and fetus. Indeed, the PIH resolves postpartum it causes various maternal and fetal morbidity and mortality [2]. Growth retardation and fetal mortality are the serious complications in PIH pregnancy. The development of PIH often required medications to control the BP. Antihypertensive drugs are used to control the BP within the normal range which further reduces the PIH related complications. Although various drugs are used to treat the PIH, the benefits of antihypertensive medication in PIH is inconsistent [3] and the use of antihypertensive medication as well as treatment targets in PIH remains controversial [4]. The chosen drug should be safe and effective to both mother and fetus in terms of reduction in PIH complications. Hence this study was planned to find out the differences in treatment outcome between the different types of antihypertensive drugs used in the treatment of PIH.The study was approved by the Institutional ethics committee (EC/AP/102/09-2009, Date: 12-08-2009) at kovai medical center and hospital, Coimbatore, Tamilnadu, India. The observational study was carried out at kovai medical center and hospital from January 2009 to December 2014. A ...
Background: The adoption of guideline recommendations of pharmacotherapy to improve the clinical course of Heart Failure (HF) remains below par. Our objective is to evaluate the impact of clinical audit on adherence to the Guideline-Directed Medical Therapy (GDMT) in patients admitted with acute heart failure with reduced ejection fraction (EF). Methods: A prospective interventional study was conducted over a period of 12 months from June 2018 to May 2019 in all patients admitted with acute heart failure with reduced ejection fraction. The discharge prescriptions of patients who met the inclusion criteria were audited for appropriateness in the usage of neurohormonal blockers and Ivabradine, by a clinical pharmacist on a monthly basis. Audit results were presented to the practicing physicians every month and feedback was given. Results: Discharge prescriptions of 716 patients who presented with HF were audited for the reasonable or unreasonable omission of neurohormonal blocking drugs. The first-month audit revealed that the unreasonable omission of Angiotensin-Converting Enzyme Inhibitors/ Angiotensin Receptor Blockers/ Angiotensin Receptor Neprilisin Inhibitors ( ACEI/ARB/ARNI), Betablockers and Mineralocorticoid Receptor Antagonists (MRA) were 24.5%, 13.1%, and 9.09% respectively, which reduced to nil at the end of the study period (p=0.00). Initiation of Ivabradine before prescribing or achieving the target dose of Betablocker was noted in 38.18% of patients in the first month, which was also reduced to nil (p=0.00) at the end of the study. Conclusion: This study reveals that periodic clinical audit improves adherence to GDMT in patients admitted with heart failure with reduced ejection fraction.
BACKGROUND Carpal tunnel syndrome is the commonest entrapment neuropathy where median nerve gets entrapped in the tunnel formed by transverse carpal ligament (which is an unyielding fibrous structure) and carpal bones. Carpal tunnel syndrome prevails among individuals whose occupation need repeated wrist movements and also in certain medical conditions like diabetes mellitus, rheumatoid arthritis and hypothyroidism. Electrophysiological study of median nerve at wrist and ultrasonogram of the wrist helps in diagnosing carpal tunnel syndrome and to plan management. Aim-To evaluate the clinical, electrophysiological and ultrasonographic profile of patients presenting with symptoms of carpal tunnel syndrome (CTS). MATERIALS AND METHODS The study was conducted at Neurology Department, Government Stanley Medical College Hospital between January 2017 and August 2017. All subjects who satisfied the inclusion criteria and given their consent for the study underwent detailed neurological evaluation followed by biochemical investigations, electrophysiological study and ultrasonogram of both wrists. Biochemical investigations done were fasting blood sugar, postprandial blood sugar, thyroid profile, renal function test and rheumatoid arthritis factor. All patients who presented with paraesthesia of hands, mainly tingling or numbness in the median nerve distribution with or without objective signs of Tinel or Phalen were included in the study. Patients who have been previously diagnosed and on treatment for symptoms of carpal tunnel syndrome and other causes of neuropathy were excluded. SPSS software and Chi-square test were used for statistical analysis. Study Design-A cross-sectional descriptive study. RESULTS Most common age group affected was between 40 and 50 years with Female: Male ratio 3: 1 indicating female predilection. Dominant right hand is commonly involved compared to left hand. Type 2 diabetes was found in 30.6% and hypothyroidism was found in 11.3% in the study. In Electrophysiological Study (EPS), moderate grade was found in 50% of the patients. Ultrasonogram of the wrist had positive correlation irrespective of electrophysiological grading. CONCLUSION Bilateral carpal tunnel syndrome patients had severe electrophysiological grade with positive correlation with ultrasonogram of wrist helping in deciding the mode of treatment-medical versus surgical.
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