Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 84
Filtrar
1.
Heart ; 107(20): 1629-1682, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34561249
2.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34472787

RESUMO

BACKGROUND: The present study intended to estimate the comorbidities and risk factors among patients with hypertension in India. Further, the current practice of hypertension management was evaluated and the choice of therapy was assessed based on hypertension grade, risk factors, and comorbidities. METHODS: Electronic medical record data (June 2017-June 2019) of Indian adult hypertensive patients (≥140/90 mmHg) who had two blood pressure (BP) readings were retrospectively analyzed. Demographic characteristics, BP readings, comorbidities, medications and co-medications, and laboratory data were collected at baseline. Grids based on hypertension grade (I, II, and III), demographic factors, risk factors, and comorbidities were created and prescribed antihypertensive drugs (AHDs) in each grid were evaluated. RESULTS: Among 100,075 patients, the proportion of patients in 18-40 year, 40-65 year, and >65 year age groups were 11.4%, 65.1%, and 23.4%, respectively. Proportion of men and women was similar (52.0% vs 47.9%). Proportion of patients with BMI <25 Kg/m2 was 8.1%, 25-29.9 Kg/m2 was 11.9%, and >30 Kg/m2 was 8.8%. Mean BP of patients with hypertension was: grade I (145.05/90.73 mmHg), grade II (160.07/95.64 mmHg), and grade III (180.82/102.76 mmHg). Mean low density lipoprotein (113.26 mg/dL), serum creatinine (2.28 mg/dL), mean HbA1c (8.7%) levels were highest among patients with grade III hypertension. Commonly observed comorbidities were type 2 diabetes mellitus (T2DM: 51.5%), dyslipidemia (36.4%), and chronic kidney disease (CKD: 4.4%). Top concomitant medications included anti-diabetic therapies (34.6%), drugs for dyslipidemia (30.0%), and anti-platelet therapies (6.9%). CONCLUSION: Most prescribed AHD monotherapies were angiotensin receptor II blockers (ARBs) and calcium channel blockers (CCBs) and most prescribed combination therapies were ARBs + diuretics and ARBs + CCBs. Telmisartan and amlodipine+telmisartan for patients with comorbid T2DM or dyslipidemia and metoprolol for those with coronary artery disease were the commonly prescribed AHDs.


Assuntos
Diabetes Mellitus Tipo 2 , Hipertensão , Adolescente , Adulto , Idoso , Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
3.
4.
J Cardiovasc Electrophysiol ; 32(10): 2729-2736, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34374160

RESUMO

BACKGROUND: Patients with wire and catheter refractory venous occlusion are traditionally referred for pectoral transvenous lead extraction (TLE) to obtain venous access. TLE causes 1-2 mm circumferential mechanical or laser destruction of tissue surrounding the lead(s). This not only exposes the patient to the risk of major complications but also can damage nontargeted leads. We present a series of patients where retained wire femoral lead removal and fibroplasty was used to obtain venous access in patients with refractory obstruction. METHODS: Between 2008 and 2021, we identified 17 patients where retained wire lead removal followed by fibroplasty was used to retain venous access. Demographic and procedural data were obtained by retrospective review of patient charts. RESULTS: We were able to successfully obtain venous access in all 17 patients in whom this technique was attempted. In two patients the target lead was less than or equal to 1 year old. In the remaining 15 patients, the average dwell time of the target lead(s) was 6 years. There were no procedure-related complications, and no changes in the parameters of other leads were noted. CONCLUSION: Retained wire femoral lead removal and fibroplasty is safe and highly efficacious at obtaining venous access in patients with refractory venous occlusion. If the target lead(s) is less than or equal to 1 year old, this technique can help obtain venous access at the time of the initial surgery, hence avoiding the need for TLE. Furthermore, in patients referred for TLE to obtain venous access, this technique by avoiding the use of TLE tools spares the patient of the associated risks.

5.
Indian J Ophthalmol ; 69(7): 1850-1855, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34146042

RESUMO

Purpose: The aim of this work was to study various retinochoroidal parameters in patients with obstructive sleep apnea syndrome (OSAS) and the effect of interventions on these parameters at 6 months follow-up. Methods: A total of 36 patients were recruited prospectively from the otorhinolaryngology clinics of a large tertiary center between September 2018 to March 2020. The subjects were divided into three groups depending upon intervention chosen for OSAS: Group A (surgery, i.e., uvulopalatopharyngoplasty), group B (medical therapy, i.e., continuous positive air pressure) and group C (no intervention). Various retinochoroidal parameters which were studied included retinal thickness (RT), choroidal thickness (CT), choroidal vascularity index (CVI), arteriovenous ratio (AVR), capillary density index (CDI) in superficial and deep retina, at baseline and 6 months of follow-up after the intervention. Results: In group A, CT increased significantly at 6 months (332.76 ± 86.41 um) compared to baseline (306.28 ± 78.19) (P = 0.0004). Similarly, CDI at both superficial and deep capillary plexus increased significantly at 6 months (superficial CDI: 0.65 ± 0.04, deep CDI: 0.38 ± 0.01) compared to baseline (superficial CDI: 0.62 ± 0.03, deep CDI: 0.36 ± 0.02) (P = 0.004 and 0.002 respectively). In group B, CT increased significantly at 6 months (361.38 ± 78.63 um) compared to baseline (324.21 ± 76.97 um) (P = 0.008). Also, CVI showed a significant decrease at 6 months (65.74 ± 1.84%) compared to baseline (67.36 ± 1.57%) (P = 0.019). In group C, all except CDI in deep capillary plexus showed a significant decrease at 6 months (0.35 ± 0.01) compared to baseline (0.36 ± 0.02) (P = 0.003). Conclusion: OSAS alters various retinochoroidal parameters and timely intervention in patients with OSAS can prevent these alterations. Also, these retinochoroidal parameters could serve as one of the markers to monitor the disease progression.


Assuntos
Apneia Obstrutiva do Sono , Pressão do Ar , Corioide , Humanos , Retina , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/cirurgia
6.
Artigo em Inglês | MEDLINE | ID: mdl-34104634

RESUMO

Providing medical care using the telecommunication networks holds the promise of increased access and efficiency of healthcare particularly during global emergencies like the Coronavirus disease 2019 (COVID-19) pandemic. Most of the hospital setups worldwide have put telemedicine into practice ever since the onset of the COVID-19 pandemic. This study aimed at assessing the effectiveness of Tele-otolaryngology (TO) at a tertiary care centre during the pandemic lockdown. A validated patient feedback questionnaire was developed and distributed to 2577 patients who utilised the TO mobile health service at our institute. Patient feedback-based assessment of TO effectiveness during COVID-19 lockdown was carried out. The validated questionnaire in English and Hindi was statistically robust with Cronbach's alpha value of 0.808 and 0.886 respectively. 1751 patients completed their feedback to the questionnaire. 97.5% utilised WhatsApp for TO consultation. 15.2% patients were detected of Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection with TO guidance. Up to 75% patients had a positive response to the questionnaire and 91.1% opined of savings achieved either with travel time, cost incurred or the treatment time. With respect to patient health status, 71.5% recovered, 20.1% had no change and 8.4% deteriorated with a mortality rate of 1.65%. Telehealth in otolaryngology during the COVID-19 pandemic lockdown was indispensable in managing exigencies. Redesigning of clinical protocol and technical constraints, clinician training and a validated patient feedback questionnaire would effectively bestow upon the global emergencies.

7.
NPJ Prim Care Respir Med ; 31(1): 29, 2021 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-34035312

RESUMO

Chronic obstructive pulmonary disease (COPD) treatment guidelines do not currently include recommendations for escalation directly from monotherapy to triple therapy. This 12-week, double-blind, double-dummy study randomized 800 symptomatic moderate-to-very-severe COPD patients receiving tiotropium (TIO) for ≥3 months to once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 mcg via ELLIPTA (n = 400) or TIO 18 mcg via HandiHaler (n = 400) plus matched placebo. Study endpoints included change from baseline in trough forced expiratory volume in 1 s (FEV1) at Days 85 (primary), 28 and 84 (secondary), health status (St George's Respiratory Questionnaire [SGRQ] and COPD Assessment Test [CAT]) and safety. FF/UMEC/VI significantly improved trough FEV1 at all timepoints (Day 85 treatment difference [95% CI] 95 mL [62-128]; P < 0.001), and significantly improved SGRQ and CAT versus TIO. Treatment safety profiles were similar. Once-daily single-inhaler FF/UMEC/VI significantly improved lung function and health status versus once-daily TIO in symptomatic moderate-to-very-severe COPD patients, with a similar safety profile.

8.
Acta Cardiol ; 76(6): 678-679, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33998946
9.
J Invasive Cardiol ; 33(4): E312-E313, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33794479

RESUMO

A 12-year-old boy with complex cyanotic congenital heart disease with single-ventricle physiology was planned for univentricular repair. Aortopulmonary collateral occlusion using thrombotic embolization coils was planned, but during the procedure, there was perforation of an aortopulmonary collateral arising from the descending thoracic aorta. The teaching point from this case is that all aortopulmonary collaterals do not necessarily need to be occluded; when occlusion is performed, coils must be appropriately sized.


Assuntos
Embolização Terapêutica , Cardiopatias Congênitas , Criança , Circulação Colateral , Humanos , Masculino , Artéria Pulmonar
10.
BMJ Case Rep ; 14(4)2021 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910799

RESUMO

Tongue trauma with active bleed is most commonly due to the ruptured lingual artery and its branches, whereas delayed haemorrhage is usually secondary to pseudoaneurysm formation. This case is a unique presentation of traumatic tongue bleeds with early formation of pseudoaneurysm of a lingual artery branch. We present our experience in its management. A contrast-enhanced CT (CECT) with angiography detected right deep lingual artery pseudoaneurysm, which was managed by endovascular gelfoam embolisation followed by tongue laceration repair. Tongue bleed stopped immediately post embolisation; tongue viability and functions restored on postoperative day 1 of repair. No complications like secondary haemorrhage or tongue necrosis were noted at 1-month follow-up. High index of suspicion for lingual artery and/or its branch pseudoaneurysm is crucial in acute and uncontrollable traumatic tongue bleed. A CECT is a minimum norm in early diagnosis. Choice of management is the cornerstone of a successful outcome.


Assuntos
Falso Aneurisma , Embolização Terapêutica , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Angiografia , Artérias , Hemorragia/etiologia , Hemorragia/terapia , Humanos
11.
Indian Heart J ; 73(2): 249-252, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33865531

RESUMO

The exploratory analysis of FOURIER trial has offered a ray of hope for patients with nonrheumatic aortic stenosis (AS). At present, the only definitive treatment of severe AS is aortic valve replacement (AVR). Despite transaortic valvular replacement revolutionizing the treatment of AS, it still remains a progressive condition, with no disease-modifying pharmacotherapy. Angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, eplerenone, nitrates and statins all have been tried previously but failed to slow down the progression of aortic stenosis. Recently, there has been an emerging role of lipoprotein A [Lp(a)] in the pathogenesis of AS. This raises the possibility that long-term therapy with specific emphasis on Lp(a) reduction may reduce or slow the progression of AS.

12.
J Invasive Cardiol ; 33(3): E225-E226, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33646967

RESUMO

A 52-year-old woman presented to another hospital with progressive dyspnea of 10-day duration. The patient was diagnosed with a massive pericardial effusion and underwent pericardiocentesis. However, the patient's symptoms did not improve and she was referred to our hospital with a pericardial sheath in situ. On evaluation, the patient had a large pericardial effusion and evidence of cardiac tamponade, but no fluid could be aspirated from the sheath. This case underscores the importance of image-guided pericardiocentesis.


Assuntos
Tamponamento Cardíaco , Derrame Pericárdico , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/cirurgia , Cateterismo , Feminino , Coração , Humanos , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/etiologia , Derrame Pericárdico/cirurgia , Pericardiocentese
13.
J Invasive Cardiol ; 33(3): E231-E232, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33646971

RESUMO

A 25-year-old man came to our clinic with the complaints of exertional palpitations and dyspnea. He had skeletal features suggestive of Marfan's syndrome. Contrast-enhanced computed tomography confirmed aneurysmal dilation of the aortic root and the proximal part of the ascending aorta. The patient was advised to undergo Bentall procedure for replacement of the aortic valve, aortic root, and ascending aorta. Marfan's syndrome is a connective tissue disorder with autosomal-dominant inheritance. Patients have a predisposition for progressive aortic root and ascending aortic dilation, and should undergo periodic echocardiographic monitoring.


Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Síndrome de Marfan , Adulto , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Valva Aórtica , Humanos , Masculino , Síndrome de Marfan/complicações , Síndrome de Marfan/diagnóstico
14.
J Invasive Cardiol ; 33(1): E70, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33385992

RESUMO

Coronary-cameral fistula (CCF) is a rare congenital communication between a coronary artery and a cardiac chamber or a great vessel. Most patients are asymptomatic and these lesions are incidentally detected during coronary angiography, with the reported incidence being up to 0.2%. The most frequent draining sites are right ventricle, right atrium, and pulmonary arteries, with less frequent drainage to the left side of the heart. The majority of CCFs are hemodynamically inconsequential and do not require treatment. However, when large, these lesions can cause myocardial ischemia by causing coronary steal or high-output heart failure, and should be treated. Treatment modalities include transcatheter closure with embolic agents (microcoil or gelfoam) and surgical ligation. Choice of therapy is governed by size of the CCF, tortuosity of the feeder channel, size of the communication to prevent embolization, and concomitant coronary artery disease.


Assuntos
Doença da Artéria Coronariana , Artéria Pulmonar , Fístula Vascular , Angiografia Coronária , Humanos , Artéria Pulmonar/diagnóstico por imagem , Fístula Vascular/diagnóstico , Fístula Vascular/etiologia
15.
J Invasive Cardiol ; 32(12): E378, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33257590

RESUMO

During inflation of the Inoue balloon during a balloon mitral valvotomy, indentation and compression of the Inoue balloon was seen. This is indirect evidence of severe subvalvular disease.

19.
J Fluoresc ; 30(4): 773-785, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32418161

RESUMO

An adept, rapid and novel water-soluble glutathione functionalized CdS quantum dots (GSH@CdS QDs) were fabricated using green pathway for sensing of heavy metal contamination prevalent in industrial wastewater. GSH@CdS QDs were facilely synthesized in an aqueous phase reaction and were effectively characterized using FT-IR, XRD, FESEM, HRTEM and EDX techniques. The distinct fluorescence characteristics of GSH@CdS QDs were explored and the QDs showed selective sensitivity towards mercury ions with a low limit of detection of 0.54 nM under optimal conditions. The detailed interaction between GSH@CdS QDs and Hg2+ and the probable fluorescence quenching mechanism were established in this study. In comparison to already reported fluorescent probes, GSH@CdS QDs showed high sensitivity, biocompatibility, long fluorescence stability and convenient removal of mercury ions. Graphical Abstract Facile green route for the fabrication of glutathione capped CdS quantum dots for fluorescence-based detection of toxic Hg2+ ions.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...