RÉSUMÉ
Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin-angiotensin-aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective ß1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities.
Sujet(s)
Antagonistes des récepteurs aux angiotensines , Bisoprolol , Insuffisance rénale chronique , Inhibiteurs du cotransporteur sodium-glucose de type 2 , Humains , Insuffisance rénale chronique/complications , Insuffisance rénale chronique/traitement médicamenteux , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Inde/épidémiologie , Bisoprolol/usage thérapeutique , Antagonistes des récepteurs aux angiotensines/usage thérapeutique , Consensus , Antagonistes des récepteurs bêta-1 adrénergiques/usage thérapeutiqueRÉSUMÉ
Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF.
Sujet(s)
Diabète de type 2 , Défaillance cardiaque , Inhibiteurs du cotransporteur sodium-glucose de type 2 , Humains , Inhibiteurs du cotransporteur sodium-glucose de type 2/usage thérapeutique , Défaillance cardiaque/traitement médicamenteux , Inde , Diabète de type 2/traitement médicamenteux , Diabète de type 2/complicationsRÉSUMÉ
Atrial fibrillation (AF) is a significant risk factor for stroke. Based on the higher stroke associated with AF in the South Asian population, we constructed a one-year stroke prediction model using machine learning (ML) methods in KERALA-AF South Asian cohort. External validation was performed in the prospective APHRS-AF registry. We studied 2101 patients and 83 were to patients with stroke in KERALA-AF registry. The random forest showed the best predictive performance in the internal validation with receiver operator characteristic curve (AUC) and G-mean of 0.821 and 0.427, respectively. In the external validation, the light gradient boosting machine showed the best predictive performance with AUC and G-mean of 0.670 and 0.083, respectively. We report the first demonstration of ML's applicability in an Indian prospective cohort, although the more modest prediction on external validation in a separate multinational Asian registry suggests the need for ethnic-specific ML models.
Sujet(s)
Fibrillation auriculaire , Accident vasculaire cérébral , Humains , Fibrillation auriculaire/complications , Fibrillation auriculaire/diagnostic , Fibrillation auriculaire/épidémiologie , Études prospectives , Apprentissage machine , Enregistrements , Accident vasculaire cérébral/épidémiologie , Accident vasculaire cérébral/étiologie , Accident vasculaire cérébral/prévention et contrôleRÉSUMÉ
;Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril-Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril-Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril-Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril-Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40-50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.
Sujet(s)
Défaillance cardiaque , Humains , Défaillance cardiaque/traitement médicamenteux , Néprilysine/pharmacologie , Débit systolique/physiologie , Tétrazoles/usage thérapeutique , Tétrazoles/pharmacologie , Qualité de vie , Fonction ventriculaire gauche , Antagonistes des récepteurs aux angiotensines/usage thérapeutique , Antagonistes des récepteurs aux angiotensines/pharmacologie , Résultat thérapeutique , Antihypertenseurs/usage thérapeutique , Association médicamenteuseRÉSUMÉ
Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.
Sujet(s)
Anémie par carence en fer , Défaillance cardiaque , Carences en fer , Humains , Anémie par carence en fer/étiologie , Anémie par carence en fer/complications , Qualité de vie , Fer/usage thérapeutique , Défaillance cardiaque/complications , Défaillance cardiaque/traitement médicamenteuxRÉSUMÉ
Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ß-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).
Sujet(s)
Défaillance cardiaque , Néprilysine , Humains , Néprilysine/pharmacologie , Remodelage ventriculaire , Tétrazoles/pharmacologie , Résultat thérapeutique , Antagonistes des récepteurs aux angiotensines/usage thérapeutique , Débit systolique , Défaillance cardiaque/traitement médicamenteux , Défaillance cardiaque/diagnostic , AntihypertenseursRÉSUMÉ
In India, heart failure (HF) is an important health concern affecting younger age groups than the western population. A limited number of Indian patients receive guideline-directed medical therapy (GDMT). Selective ß-1 blockers (BB) are one of the GDMTs in HF and play an important role by decreasing the sympathetic overdrive. The BB reduces heart rate (HR) reverse the adverse cardiac (both ventricular and atrial), vascular, and renovascular remodeling seen in HF. Bisoprolol, a ß-1 blocker, has several advantages and can be used across a wide spectrum of HF presentations and in patients with HF and comorbid conditions such as coronary artery disease (CAD), atrial fibrillation (AF), post-myocardial infarction (MI), uncontrolled diabetes, uncontrolled hypertension, and renal impairment. Despite its advantages, bisoprolol is not optimally utilized for managing HF in India. This consensus builds on updated evidence on the efficacy and safety of bisoprolol in HF and recommends its place in therapy with a focus on Indian patients with HF.
Sujet(s)
Antagonistes des récepteurs bêta-1 adrénergiques , Bisoprolol , Défaillance cardiaque , Humains , Bisoprolol/usage thérapeutique , Défaillance cardiaque/traitement médicamenteux , Inde , Antagonistes des récepteurs bêta-1 adrénergiques/usage thérapeutique , ConsensusRÉSUMÉ
Background: Colonoscopy is an important procedure in the management of colorectal diseases. During a colonoscopy, one can visualize the mucosa of the large bowel and perform therapeutic procedures. Aim: The aim of this study is to review the indications and findings of colonoscopy in our center. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. Patients and Methods: The study is a retrospective descriptive one and included all patients who underwent colonoscopy between June 2017 to December 2019 at the endoscopy unit of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Data on age, gender, indications, and findings at endoscopy were extracted from the endoscopy unit register. The data obtained were analyzed using the Statistical Package for the Social Sciences (SPSS) statistical software version 20. Results: One hundred and twenty-five patients had a colonoscopy during the period under review with a male to female ratio of 1.9:1. The age range of the patients was 3 to 85 years and the mean age was 46.7 ± 16.7 The most common indications for colonoscopy in our center were lower gastrointestinal bleeding (40 (32%)), followed by suspected colonic tumors (37 (29.6%)), and hemorrhoids (18 (14.4%)). The commonest findings were hemorrhoids (50 (40%)), colonic tumors (25 (20%)), and colitis (21 (16.8%)). Conclusion: A colonoscopy is an effective tool in the management of colorectal diseases. Lower gastrointestinal bleeding was the commonest indication for colonoscopy in our center and hemorrhoids and colorectal tumors were the commonest findings.
Sujet(s)
Maladies du côlon , Tumeurs du côlon , Tumeurs colorectales , Hémorroïdes , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Enfant , Enfant d'âge préscolaire , Maladies du côlon/diagnostic , Coloscopie/méthodes , Femelle , Hémorragie gastro-intestinale/étiologie , Humains , Mâle , Adulte d'âge moyen , Nigeria , Études rétrospectives , Jeune adulteRÉSUMÉ
BACKGROUND: We report patient characteristics, treatment pattern and one-year clinical outcome of nonvalvular atrial fibrillation (NVAF) from Kerala, India. This cohort forms part of Kerala Atrial Fibrillation (KERALA-AF) registry which is an ongoing large prospective study. METHODS: KERALA-AF registry collected data of adults with previously or newly diagnosed atrial fibrillation (AF) during April 2016 to April 2017. A total of 3421 patients were recruited from 53 hospitals across Kerala state. We analysed one-year follow-up outcome of 2507 patients with NVAF. RESULTS: Mean age at recruitment was 67.2 years (range 18-98) and 54.8% were males. Main co-morbidities were hypertension (61.2%), hyperlipidaemia (46.2%) and diabetes mellitus (37.2%). Major co-existing diseases were chronic kidney disease (42.1%), coronary artery disease (41.6%), and chronic heart failure (26.4%). Mean CHA2DS2-VASc score was 3.18 (SD ± 1.7) and HAS-BLED score, 1.84 (SD ± 1.3). At baseline, use of oral anticoagulants (OAC) was 38.6% and antiplatelets 32.7%. On one-month follow-up use of OAC increased to 65.8% and antiplatelets to 48.3%. One-year all-cause mortality was 16.48 and hospitalization 20.65 per 100 person years. The main causes of death were cardiovascular (75.0%), stroke (13.1%) and others (11.9%). The major causes of hospitalizations were acute coronary syndrome (35.0%), followed by arrhythmia (29.5%) and heart failure (8.4%). CONCLUSIONS: Despite high risk profile of patients in this registry, use of OAC was suboptimal, whereas antiplatelets were used in nearly half of patients. A relatively high rate of annual mortality and hospitalization was observed in patients with NVAF in Kerala AF Registry.
Sujet(s)
Anticoagulants/administration et posologie , Fibrillation auriculaire/thérapie , Enregistrements , Accident vasculaire cérébral/épidémiologie , Administration par voie orale , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Fibrillation auriculaire/mortalité , Fibrillation auriculaire/physiopathologie , Relation dose-effet des médicaments , Femelle , Études de suivi , Humains , Mâle , Adulte d'âge moyen , Études prospectives , Accident vasculaire cérébral/étiologie , Accident vasculaire cérébral/prévention et contrôle , Taux de survie/tendances , Facteurs temps , Jeune adulteRÉSUMÉ
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
Sujet(s)
Maladies cardiovasculaires/imagerie diagnostique , Infections à coronavirus/prévention et contrôle , Infection croisée/prévention et contrôle , Échocardiographie/méthodes , Pandémies/prévention et contrôle , Sécurité des patients , Pneumopathie virale/prévention et contrôle , COVID-19 , Cardiologie , Maladies cardiovasculaires/épidémiologie , Infections à coronavirus/épidémiologie , Femelle , Humains , Inde , Prévention des infections/méthodes , Mâle , Pandémies/statistiques et données numériques , Pneumopathie virale/épidémiologie , Guides de bonnes pratiques cliniques comme sujet , Syndrome respiratoire aigu sévère/épidémiologie , Syndrome respiratoire aigu sévère/prévention et contrôle , Sociétés médicalesRÉSUMÉ
BACKGROUND: Upper gastrointestinal bleeding (UGIB) is a common medical emergency that can result in significant morbidity and mortality. AIM: The aim of this study was to determine the demographic profile and etiology of UGIB in patients seen at Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, North-Western Nigeria. SUBJECTS AND METHODS: This descriptive retrospective study was carried out at the Gastroenterology Unit of ABUTH Zaria. Data of patients referred for upper gastrointestinal endoscopy with UGIB from June 2017 to December 2019 were extracted from the endoscopy register and analyzed. RESULTS: One hundred and forty-four patients had upper gastrointestinal (UGI) endoscopy done for UGIB during the period under review. Of these, 105 (72.9%) were males while 39 (27.1%) were females with male-to-female ratio of 2.7:1. The mean age of the patients was 43.5 ± 17.3 and their age ranges from 11 to 89 years. The modal age group was 40-49 years. The most common cause of UGIB was esophageal varices (67 [46.5%]) followed by erosive mucosal diseases: gastritis/duodenitis 43 (29.9%), esophagitis 12 (8.3%). Less common causes were peptic ulcer disease (PUD) in five (3.5%) patients, gastric tumor in two (1.4%), hiatus hernia in one (0.7%), and portal hypertensive gastropathy in one (0.7%). Thirteen patients (9.0%) had normal findings. CONCLUSION: Esophageal varices are the most common cause of UGIB among our patients and middle-aged male patients were the most commonly affected group.
Sujet(s)
Endoscopie gastrointestinale/méthodes , Varices oesophagiennes et gastriques/complications , Hémorragie gastro-intestinale/imagerie diagnostique , Ulcère peptique/complications , Adolescent , Adulte , Répartition par âge , Sujet âgé , Sujet âgé de 80 ans ou plus , Enfant , Service hospitalier d'urgences , Endoscopie gastrointestinale/effets indésirables , Varices oesophagiennes et gastriques/épidémiologie , Femelle , Gastrite/complications , Gastrite/épidémiologie , Hémorragie gastro-intestinale/épidémiologie , Hémorragie gastro-intestinale/étiologie , Hôpitaux d'enseignement , Humains , Mâle , Adulte d'âge moyen , Nigeria/épidémiologie , Ulcère peptique/épidémiologie , Études rétrospectives , Répartition par sexe , Jeune adulteRÉSUMÉ
Heart failure (HF) is recognized as a major public health problem in both the low and high- income countries. However, data are scarce on the burden, prevailing practice patterns and long-term health outcomes of HF patients in India. The Kerala heart failure registry (KHFR) is a multi-centric, prospective, and hospital based registry in Kerala, India. Consecutive patients admitted with the diagnosis of acute heart failure satisfying the European Society of Cardiology (ESC) criteria will be enrolled in the registry. Data on demographic, clinical, laboratory, imaging, other diagnostics and therapeutic approaches employed and the usage of guideline based medical therapy will be collected as part of the registry. Additionally, all registered patients will be followed-up regularly at 1-month, and thereafter at every 3-months. Both mortality and hospital admission data will be collected during the follow-up visits. We will be recruiting 7500 HF patients in the KHFR. Once completed, KFHR is going to be the largest HF registry in India. We will validate a HF mortality risk score developed based on a previously conducted Trivandrum Heart Failure Registry in the KHFR patients.
Sujet(s)
Cardiologie/méthodes , Prise en charge de la maladie , Défaillance cardiaque/thérapie , Enregistrements , Plan de recherche , Maladie aigüe , Humains , IndeRÉSUMÉ
UNLABELLED: Parathyroidectomy is a difficult and lengthy operation which is noncurative in 6% to 10% of cases. To improve the efficiency of this operation, a new dual diagnostic approach was prospectively applied. METHODS: Preoperative tomographic 99mTc-sestamibi (MIBI) scintography and intraoperative measurements of circulating parathyroid hormone (PTH) levels by a quick assay (QPTH) were used. Scintigraphy comprised immediate and delayed planar and SPECT of the neck and chest, following 20 mCi MIBI. The presence and location of persistent foci of abnormal activity found within the neck mediastinum on volume-rendered reprojection (RPJ) of the SPECT data were reported. The surgion, guided by the three-dimensional MIBI-SPECT/RPJ images, identified and excised the single or most prominent scintigraphic focus and applied the QPTH. If PTH levels fell from baseline by at least 50%, the operation was concluded. RESULTS: The operative time of primary parathyroidectomy was reduced from an average of 90 min (before the introduction of scintigraphy and intraoperative PTH measurements) to 57 min. All but two patients became normocalcemic. In 58 consecutive patients with hyperparathyroidism, MIBI-SPECT/RPJ correctly and precisely identified 51 of 53 (96%) primary parathyroid adenomas, 14 to 15 secondary hyperplasias and 2 of 3 hyperplastic glands in MEN (sensitivity 94%, specificity 92%). QPTH verified the excision of the primary parathyroid adenomas and predicted normocalcemia in 50 of 52 patients. In 6 patients with misleading scintigraphy, QPTH was especially useful and guided the surgeon to continue the operation until the abnormal parathyroid tissue was found and excised. CONCLUSION: MIBI-SPEC/RPJ and QPTH sequentially applied improved the efficiency of parathyroidectomy.
Sujet(s)
Hyperparathyroïdie/chirurgie , Hormone parathyroïdienne/sang , Parathyroïdectomie/méthodes , Technétium (99mTc) sestamibi , Tomographie par émission monophotonique , Adénomes/diagnostic , Adénomes/chirurgie , Femelle , Humains , Hyperparathyroïdie/diagnostic , Traitement d'image par ordinateur , Dosage immunologique/méthodes , Mâle , Surveillance peropératoire/méthodes , Tumeurs de la parathyroïde/diagnostic , Tumeurs de la parathyroïde/chirurgie , Soins préopératoires , Sensibilité et spécificité , Facteurs tempsRÉSUMÉ
UNLABELLED: We report a pilot study of radioimmunoscintigraphy (RIS) and operative gamma probe scintimetry (OPS) using a 99mTc-labeled anti-cytokeratin human monoclonal antibody (MAb) (99mTc-88BV59) in patients with newly diagnosed, recurrent or metastatic colorectal cancer. METHODS: Twelve presurgical patients with biopsy- or contrast radiographic-proven colorectal cancer or recurrent colorectal carcinoma were studied. After chest roentgenography and abdominopelvic CT, 99mTc-88BV59 was administered intravenously, planar and SPECT external imaging was performed 3 to 6 hr after injection and planar imaging was performed 18 to 24 hr after injection. Surgery was performed immediately after late planar imaging. OPS of a standardized list of sites to document background radiation activity and of tumor sites, resection margins and tumor beds was performed. RESULTS: The patients had 23 histologically proven tumor sites. Overall sensitivity for CT, planar RIS, SPECT, surgery and OPS was 43%, 61%, 78%, 96% and 91%, respectively. SPECT was superior to CT for imaging extrahepatic abdominal and pelvic disease. OPS detected all liver and extrahepatic abdominal tumor sites and correctly predicted histological tumor-free margins and tumor beds in all cases. OPS did not identify tumor deposits that the surgeon could neither see nor feel. No patient demonstrated human anti-human immune responsiveness 1 and 3 mo after 99mTc-88BV59 infusion. CONCLUSION: Technetium-99m-88BV59 is a safe, effective radioimmunoconjugate for colorectal cancer imaging, with superior sensitivity as compared to CT.
Sujet(s)
Tumeurs colorectales/imagerie diagnostique , Sujet âgé , Anticorps monoclonaux , Tumeurs colorectales/anatomopathologie , Tumeurs colorectales/chirurgie , Femelle , Humains , Période peropératoire , Mâle , Adulte d'âge moyen , Métastase tumorale/imagerie diagnostique , Projets pilotes , Études prospectives , Radioimmunodétection , Sensibilité et spécificité , Technétium , Tomographie par émission monophotonique , TomodensitométrieRÉSUMÉ
Single photon emission computed tomography (SPECT) with Technetium-99m hexamethyl propylenamine oxime (Tc-99m-HMPAO) was used in 20 patients with mild to moderate traumatic brain injury (TBI) to evaluate the effects of brain trauma on regional cerebral blood flow (rCBF). SPECT scan was compared with CT scan in 16 patients. SPECT showed intraparenchymal differences in rCBF more often than lesions diagnosed with CT scans (87.5% vs. 37.5%). In five of six patients with lesions in both modalities, the area of involvement was relatively larger on SPECT scans than on CT scans. Contrecoup changes were seen in five patients on SPECT alone, two patients with CT alone and one patient had contrecoup lesions on CT and SPECT. Of the eight patients (50%) with skull fractures, seven (43.7%) had rCBF findings on SPECT scan and five (31.3%) demonstrated decrease in rCBF in brain underlying the fracture. All these patients with fractures had normal brain on CT scans. Conversely, extra-axial lesions and fractures evident on CT did not visualize on SPECT, but SPECT demonstrated associated changes in rCBF. Although there is still lack of clinical and pathological correlation, SPECT appears to be a promising method for a more sensitive evaluation of axial lesions in patients with mild to moderate TBI.