Ultrafiltration in Heart Failure: A Review.

Ultrafiltration is an effective method to get rid of fluid retention and congestion in patients with acute decompensated heart failure (HF) without affecting the circulating volume. Although its efficacy in comparison to diuretics is debatable, the evaluation of our analysis is based on various studies that comprise published clinical trials on ultrafiltration and studies comparing the efficacy of diuretics and ultrafiltration. Apart from this, we also look at literature that provides shortcomings of the said procedure and its scope for future advancements. Heart failure ultimately leads to volume overload, which is a highly concerning complication. Diuretics have been used as a first-line treatment for fluid overload but are becoming inefficacious due to the development of resistance and renal dysfunction. Ultrafiltration, on the other hand, is an attractive alternative to counter volume overload and congestion, which are unresponsive to medical therapy. There is also evidence that it significantly decreases the probability of future episodes of decompensation. There are, however, disagreements about whether ultrafiltration is an effective method to improve mortality in these patients. There is a lack of conclusive studies demonstrating the superiority of one fluid removal method over another. Hence, it is imperative to continue searching for the most effective method to treat congestion. Priority should be given to more mechanistic studies regarding ultrafiltration.

Ventricular Septal Rupture Management in Patients With Acute Myocardial Infarction: A Review.

Untreated myocardial infarction (MI) can potentially lead to many fatal complications which require immediate management. One of them is ventricular septal rupture (VSR) which necessitates the hemodynamic stabilization and closure of the septal rupture. Conventional treatment strategy involves surgical repair; however, percutaneous transcatheter repair using an occluder device is a promising upcoming approach. We conducted a detailed review of various published articles and examined the trends in incidence, risk factors, and pathophysiology of MI leading to VSR followed by an in-depth analysis of the various management strategies for the same. In the current clinical scenario, thrombolysis is an imperative management strategy that has been shown to decrease the occurrence of VSR by manifolds, more specifically in patients having ST-elevated MI. Delayed surgical closure remains the main treatment for post-infarction VSR. Other newer modalities, such as percutaneous closure devices and mechanical circulatory supports, are attractive alternative or complementary strategies to treat such patients, both postoperatively and perioperatively. However, earlier surgical repair in VSR increases the risk of mortality, and the optimal timing for VSR closure remains controversial. Despite surgical closure of VSR being the traditional treatment, it presents a considerably high operative risk. Although newer interventions such as percutaneous closure devices and mechanical circulatory supports provide impressive outcomes, their efficacy in high-risk patients remains inconclusive.

A Comparative Review of Vagal Nerve Stimulation Versus Baroreceptor Activation Therapy in Cardiac Diseases.

Sympathetic imbalance coupled with impairment of baroreceptor control is a key factor responsible for hemodynamic abnormalities in congestive heart failure. Vagal nerve stimulation (VNS) and baroreceptor activation therapy (BAT) are two novel interventions for the same. In this paper, we review the role of sympathovagal alterations in cardiac diseases like heart failure, arrhythmia, hypertension (HTN), etc. Studies like neural cardiac therapy for heart failure (NECTAR-HF), autonomic regulation therapy to enhance myocardial function and reduce progression of heart failure (ANTHEM-HF), and baroreflex activation therapy for heart failure (BEAT-HF), which comprise the history, efficacy, limitations, and current protocols, were extensively analyzed in contrast to one another. Vagal nerve stimulation reverses the reflex inhibition of cardiac vagal efferent activity, which is caused as a result of sympathetic overdrive during the course for heart failure. It has shown encouraging results in certain pre-clinical studies; however, there is also a possibility of serious cardiovascular adverse events if given in higher than the recommended dosage. Attenuated baroreflex sensitivity is attributed to cardiac arrhythmogenesis during heart failure. Baroreceptor activation therapy reverses this phenomenon. However, the surgical procedure for baroreceptor stimulation can have unwarranted complications, including worsening heart failure and hypertension. Considering the effectiveness of the given modalities and taking into account the inconclusive evidence of their adverse events, more clinical trials are needed for establishing the future prospects of these interventional approaches.

Heterotaxy pattern associated with sinus node dysfunction in an adult: A case report.

Key Clinical Message: A 26-year-old male patient admitted to the hospital ward with experience of repetitive syncopes for a year. The patient was diagnosed with sick sinus syndrome. The aim of this clinical report is to highlight the variability of anatomical findings associated with polysplenia pattern. Abstract: This case report presents a 26-year-old male patient who presented to the medical ward with a complaint of repeating blackouts for a year. The patient was then diagnosed with sick sinus syndrome, and further investigations revealed left isomerism, polysplenia, and no congenital heart defects. Holter monitoring, ultrasonography, electrocardiography, and computed tomography were used to confirm the diagnosis. The patient underwent DDDR pacemaker implantation for the treatment of SA node dysfunction. The report highlights the variability of anatomical findings associated with polysplenia pattern and the various types of heartbeat disruptions that may occur in the atrial appendages of the left side isomerism.

Racial Disparity Between the Post-Procedural Outcomes Among Patients With Peripheral Artery Disease: A Systematic Review and Meta-analysis.

The Racial disparity between the clinical outcomes post interventions among Peripheral Artery Disease (PAD) have not been well studied, with limited literature available. We conducted a meta-analysis to evaluate the post-procedure outcomes among PAD patients between Black and White race. We systematically searched all electronic databases from inception until first November 2022. The primary endpoint was major amputation within 30 days. Secondary endpoints were myocardial infarction (MI) within 30 days, mortality within 30 days, and all-cause mortality (ACM). A total of 136,395 patients were included in the analysis, with 117,177 patients of the White race and 19,218 patients of the Black race. The mean age of the patients in each group was (66.41 vs 62.75). Most common comorbidity among White and Black patients was diabetes mellitus (42.15% vs 55.90%), and hypertension (HTN) (39.53% vs 90.07%). The odds of major amputation within 30 days was significantly higher in Black patients compared to white patients (OR, 0.40 (95% CI: 0.19-0.84, P = 0.02), while the odds of MI was higher in White patients compared to Black race PAD patients (OR, 1.29, (95%CI:1.05-1.58), P < 0.02). There was no significant difference in ACM (OR, 0.97(95%CI: 0.64-1.47, P = 0.88), and mortality within 30 days (OR, 1.09(95%CI:0.77-1.53, P = 0.64) between both groups. To our knowledge, this is the first meta-analysis with the largest sample size thus far, highlighting that Black patients are at a higher risk for major amputation within 30 days compared to white patients although mortality remains comparable between the 2 races.

Case-based learning: A 'Case' for restructuring anatomy education in Indian nursing curriculum.

BACKGROUND: Teaching anatomy in a clinical context can aid students in appreciating how the subject will apply to their future career as nurses as well as in other administrative roles. Anatomy is voluminous, making it difficult to retain the factual information in the long run; therefore, this study primarily focuses on whether case-based learning (CBL) with integrated anatomy learning can help in retention of the information over short as well as long spans of time. It also focuses on how profitable would the students be with this different style of learning, and whether it can facilitate in better understanding of the basic and clinical concepts. MATERIALS AND METHODS: The current study was conducted in the Nursing College of All India Institute of Medical Sciences, Bhopal, India to integrate CBL and evaluate its effect compared to the highly compartmentalized, didactic lectures among the nursing students. The extent of knowledge retention was analyzed by conducting a series of tests before as well as after CBL intervention. Feedback and suggestions were obtained from the students by using the 5-point Likert scale method. RESULTS: The post-test scores of the students improved by 21% after the CBL. More than 85% of the students opined that CBL improves critical thinking, team work, self-directed learning, and communication skills. CONCLUSION: CBL promotes effective short-term retention and facilitates comprehension of key concepts. CBL also plays an important role in improving the professional skills of the students, which otherwise is not taught, and equips them for their future careers.

Study of fingerprint patterns to evaluate the role of dermatoglyphics in early detection of bronchial asthma.

BACKGROUND: Dermatoglyphics and bronchial asthma (BA) are both influenced by genetic factors. Hence, we assessed the diagnostic potential of correlation between fingerprint pattern and BA. MATERIALS AND METHODS: The study was carried out in out-patient Department of Pulmonary Medicine of All India Institute of Medical Sciences Bhopal. It included 36 patients of BA and 50 nonasthmatic individuals as controls. The following parameters were studied and analyzed: (a) Whorls, (b) arches, (c) radial loops, (d) ulnar loops, (e) the absolute finger ridge count (AFRC), (f) total finger ridge count (TFRC). RESULTS: A significant decrease in the mean value of the arches and increase in the mean value of the ulnar loops were observed in BA patients compared to the control group. The mean values of TFRC, AFRC, and whorls were similar in both groups. CONCLUSION: Evaluation of dermatoglyphic patterns may be useful in identifying patients prone to developing BA.