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   Table of Contents - Current issue
July-September 2020
Volume 9 | Issue 3
Page Nos. 91-124

Online since Saturday, September 26, 2020

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Editor's Page July 2020 p. 91
Ravi R Kasliwal
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Commemorating James Lind: The man who gave us the concept of controlled clinical trials p. 92
Satyanarayana Upadhyayula, Ravi R Kasliwal
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In-Hospital and 1 year outcomes of octogenarian Indian patients with heart disease: Results from the elder heart registry p. 94
Sajan Z Ahmad, Cherian Koshy, George Koshy, Kiran Jacob, K Venugopal
Aim: The Elder Heart Registry aims to study the demographics, clinical profile, in-hospital, and 1 year outcomes of octogenarian patients (≥80 years) with acute cardiovascular disease. Materials and Methods: This is a prospective observational, longitudinal cohort, single-center registry of octogenarian cardiac patients admitted to the cardiology intensive care unit (CICU) at a tertiary care teaching hospital in Kerala, India for 2 years. Data analysis was performed using SPSS version 20 software. Results: From a total of 4199 patients admitted to the CICU, the Registry enrolled 406 patients aged ≥80 years, which constituted 9.6% of the total admissions (mean age 84.24 ± 3.67 years, male-to-female ratio of 1.15:1, mean follow-up of 1.2 years). Acute coronary syndromes (ACS) constituted 42.1% of admissions, with ST-elevation myocardial infarction in 22.2%, non-ST elevation myocardial infarction in 64.3%, and unstable angina in 13.4%. Presentation with heart failure (HF) was seen in 36.4% of patients, with HF with preserved ejection fraction (HFpEF) in 51.7%. The rates of in-hospital mortality, mortality on follow-up and rehospitalization were 14.0%, 9.3%, and 21% in the ACS group, and 9.4%, 8.1% and 18.9% in the HF group, respectively (12.1%, 8.6%, and 15.5% in the HF with reduced ejection fraction subset and 10%, 8.3%, and 20% in the HFpEF subset). Atrial fibrillation was the most common arrhythmia (16.5%). Apart from systemic hypertension (77.3%) and diabetes mellitus (53.9%), co-morbidities noted were chronic kidney disease (16.7%), obstructive airway disease (8%), thyroid disorders (4%), significant anemia (3%), depression (2.5%), and malignancy (2%). Conclusions: Octogenarians constitute almost 10% of all admissions to the CICU. ACS and HF are the major cardiac causes for hospitalization among these very elderly patients. The Elder Heart Registry is currently the largest series of octogenarian cardiac patients from India.
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Coronary artery disease among young drivers (<40 years): Occupational hazard or air pollution driving it? p. 102
Rahul S Patil, Laxmi H Shetty, Vikrant Vijan, Lakshmi Navya Cheekatla, Tency Joshu Thomas, Harmanpreet Singh, TR Raghu, CN Manjunath
Aims: To study clinico-social, biochemical and angiographic profile of patients presenting with premature coronary artery disease (PCAD) who are drivers by profession. To highlight the impact of occupational hazard and air pollution in them. Subjects and Methods: Of 3450 patients registered in the PCAD registry till date, 755 (21.88%) were found to satisfy the inclusion criteria. The data was analyzed by statistical software R version 3.5.0. Further analysis of smokers versus nonsmokers was done. Results: The average age of the group was 33.10 years. Almost all 754 (99.8%) were males, of which 323 (42.78%) smoked. The group had 83 (10.95%) diabetics and 71 (9.4%) hypertensives. Around 99 (13.11%) had a family history of coronary artery disease (CAD). Majority of them, 440 (58.27%), were urban drivers with average driving of 10 h/day. In the group, 482 (63.8%) had abnormal body mass index (BMI) and 539 (71.41%) had abdominal obesity. Low HDL was seen in 508 (67%) patients. ST-elevation myocardial infarction was the most common presentation in 415 (54.96%). Obstructive atherosclerotic CAD was seen in 217 (34.22%). Further analysis of smokers versus nonsmokers showed that hypertension, diabetes, and abnormal BMI were less common among nonsmokers, indicating the probable role of air pollution in them. Conclusions: Occupational hazard due to the stress related to prolonged driving hours, obesity, smoking and the possible role of air pollution are the important cardiovascular (CV) risks which come to light in this group of patients. Furthermore, the majority of them presented with predominant thrombotic lesions, however, smokers, who also had other CV risk factors, presented more often with obstructive atherosclerotic CAD.
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Plasma high-density lipoprotein cholesterol responses to endurance exercise training: A meta-analysis of randomized controlled trials p. 107
Manoj Kumar Choudhary, Sun Runlu, Shivir Sharma Dahal, Robin Bhattarai, Rajesh Nepal, Zhang Yuling
Background: Endurance exercise improves lipid and lipoproteins levels, while low high-density lipoprotein cholesterol (HDL-C) levels are risk factors for cardiovascular disease. There is a lack of evidence for the exercise characteristics in increasing lipids level, irrespective of the fact that endurance exercise increases lipids and lipoproteins level. The aim of this study was to clarify the effect and characteristics of endurance exercise in increasing HDL-C in randomized controlled trials. Methods: A search was performed for published studies between 1999 and 2014. Studies that assessed endurance exercise for ≥8 weeks and also reported the HDL-C levels pre- and post-training were included. The random effects model was used to measure the association between exercise and net change of HDL-C. Univariate regression analyses investigated the correlation of exercise characteristics. Subgroup and sensitivity analyses were performed to explore the sources of heterogeneity and the effect of potential confounders. The influence of pre-exercise lipid profile was assessed by meta-regression. Data were analyzed using Stata SE (12.0). Results: Fourteen studies with a total of 777 subjects were included. The mean HDL-C was reported to be increased and was statistically significant (weighted mean difference: 4.41 mg/dL; 95% confidence interval [CI]: 2.16–6.66 mg/dL, P < 0.001; I2 = 87.4%, P < 0.001). Univariate analysis indicated that exercise length was significantly associated with a net change of HDL-C (r = 0.56, P = 0.01). Nevertheless, there was no significant association between exercise frequency, duration, and total minutes. By subgroup analysis, exercise increased HDL-C level in Asia, Europe, and Africa and among all body mass index groups (P < 0.05). None of the studies omitted, in turn, seemed to substantially influence the effect of exercise on HDL-C by sensitivity analysis. Meta-regression showed that pre-exercise total cholesterol (TC) negatively correlated with net change of HDL-C (95% CI: 0.127, −0.018, r = −0073, P = 0.012). However, pre-exercise triglycerides, low-density lipoprotein cholesterol, and HDL-C did not correlate with a net change of HDL-C. Conclusions: Regular endurance exercise increases HDL-C level in any weight population. Exercise length of more than 8 weeks was the most important element of an exercise prescription. Among all lipid profiles, only the initial lower TC level responded better to exercise training and was more effective in increasing HDL-C level.
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Ebstein's anomaly with rheumatic mitral valve disease: A rare case report p. 118
Kamal Kant Jena, Janani Arul
Ebstein's anomaly (EA) is a rare congenital heart disease characterized by the apical displacement of the septal and posterior leaflets of the tricuspid valve, leading to an atrialized right ventricle. The clinical presentation is varied, depending on the severity and associated cardiac anomalies. Here, we discuss a case of a 16-year-old young girl with EA and Wolff-Parkinson-White syndrome with rheumatic mitral valve stenosis.
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Hypotension in cath lab, a rare cause… p. 121
Vivek Singh Guleria, Prafull Sharma
Sudden onset of hypotension during a procedure makes interventionalist perturbed. In cath lab, hypotension is a red flag sign, and the causes are diverse, ranging from vasovagal, cardiac tamponade, or a significant bleed somewhere, keeping the operators on their toes. We had a similar ordeal recently when a patient developed prolonged hypotension requiring inotrope and vasopressor support after local anesthesia. This case will act as a sensitizer to practitioners and make them more vigilant for the symptoms of toxicity after local anesthetic administration.
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Atrial myxoma with malignant appearance and dual arterial supply p. 123
Savvy Nandal, Anastasia Vlachadis Castles, Om Narayan
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