Importance of Dyslipidemias in Very Premature Coronary Artery Disease in India: A Registry-based Study.

BACKGROUND AND OBJECTIVE: Premature coronary artery disease (CAD) is an important cause of death in India. To identify risk factors in patients with premature CAD, we performed a registry-based study. METHODS: Consecutive patients admitted for percutaneous coronary intervention (PCI) from October 2020 to June 2021 were recruited. The patients were classified into three groups-group I (very premature CAD < 40 years), group II (premature CAD 40-59 years), and group III (nonpremature CAD > 60 years). Major risk factors were determined, and intergroup comparison was performed. RESULTS: A total of 627 patients were enrolled (men 541, women 86). Group I had 79 (12.4%), group II had 420 (66.9%), and group III had 128 (20.4%) patients. The prevalence of risk factors in groups I, II, and III, respectively, were-CAD family history in 45.1, 41.1, and 26.6% (p = 0.005), current smoking/tobacco use in 29.1, 21.0, and 10.2% (p = 0.002), hypertension in 31.6, 43.6, and 59.4% (p < 0.001), and diabetes in 22.8, 34.3, and 46.1% (p < 0.001). High total cholesterol (>170 mg/dL) was present in 50.0, 38.0, and 29.9% (p = 0.005), nonhigh-density lipoprotein (HDL) cholesterol (>100 mg/dL) in 76.9, 64.4, and 54.5% (p = 0.001), low-density lipoprotein (LDL) cholesterol (>70 mg/dL) in 85.9, 76.8, and 76.4% (p = 0.167), triglycerides (>150 mg/dL) in 56.4, 45.3, and 33.1% (p = 0.001), and very low density lipoprotein (VLDL) cholesterol (>30 mg/dL) in 24.4, 10.4, and 9.4% (p = 0.005). Age- and sex-adjusted odds ratios (OR) and 95% confidence intervals (CI) for smoking/tobacco use in groups I and II compared to group III, respectively, were 3.17 (1.60-6.27) and 2.59 (1.51-4.46); high total cholesterol 2.39 (1.29-4.13) and 1.42 (0.92-2.17); high non-HDL cholesterol 2.70 (1.45-5.03) and 1.48 (0.99-2.20); and high triglycerides 2.57 (1.44-4.58) and 1.64 (1.08-2.49). CONCLUSION: Important coronary risk factors in very premature and premature CAD in India are a family history of CAD, any tobacco use, and dyslipidemias (raised total, LDL, non-HDL, and VLDL cholesterol and triglycerides).

Declining Trend in Antimicrobial Sensitivity in Respiratory Tract Bacterial Pathogens against Commonly Used Drugs at a Tertiary Care Hospital.

OBJECTIVES: Antimicrobial resistance (AMR) is a major health issue. To determine trends in bacterial organisms in respiratory tract infections (RTIs) and their antibiotic sensitivity at a tertiary care center in India, we performed this study. METHODS: Successive samples received from January 2017 to December 2021 from the respiratory tract (sputum, endotracheal secretion, and bronchoalveolar lavage) from intensive care units and medical inpatients were processed for bacterial growth. The identification of isolates and antibiotic sensitivity patterns was performed using an automated VITEK-2 system. Descriptive statistics are reported. RESULTS: We received 7,204 respiratory samples. Significant bacterial growth was in 3,000 (41.6%), and 2,992 (41.5%) were gram-negative. Klebsiella pneumoniae was the most prevalent, followed by Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, and Enterobacter aerogenes. Increasing secular trends were observed for Klebsiella and Pseudomonas and declining trends for Acinetobacter and Escherichia (p < 0.05). Antimicrobial sensitivity patterns showed that Klebsiella, Pseudomonas, Acinetobacter, E. coli, and Enterobacter had a high sensitivity with colistin and polymyxin (99-100%). Moderate sensitivity was observed with carbapenems (Acinetobacter: 47.5%, Enterobacter: 62.0%, Escherichia: 76.5%, Klebsiella: 72.3%, Pseudomonas: 66.7%) and tigecycline (Acinetobacter: 50.4%, Enterobacter: 68.0%, Escherichia: 81.1%, Klebsiella: 66.6%, Pseudomonas: 0%). Aminoglycosides had <50% sensitivity for various organisms, and <25% sensitivity was observed with third-generation cephalosporins and quinolones. Trend analysis showed persistent sensitivity of various pathogenic bacteria to colistin and polymyxin and declining pharmacological sensitivity in Acinetobacter (carbapenems and tigecycline), Escherichia (carbapenems, quinolones, and tigecycline), Klebsiella (carbapenems, quinolones, aminoglycosides, and tigecycline), and Pseudomonas (carbapenems and aminoglycosides) species (p < 0.05). CONCLUSION: Common respiratory tract gram-negative bacterial pathogens at a tertiary care hospital are K. pneumoniae, P. aeruginosa, A. baumannii, and E. coli. All these bacteria demonstrate high sensitivity only with colistin and polymyxin. Significant AMR is observed to carbapenems, tigecycline, aminoglycosides, and third-generation cephalosporins. Secular trends show declining antimicrobial sensitivity among various bacterial pathogens.

Statins in Patients with Uncomplicated Hypertension: A Prescription Audit.

OBJECTIVE: Guidelines recommend prescription of statins in all high-risk patients with hypertension irrespective of their cholesterol levels. We performed a prescription audit in India to determine the application of recommendations. METHODS: A registry-based audit of patients with primary diagnosis of hypertension (n=3073) was performed. Details of co-morbidities and medications were obtained. Patients with known vascular disease were excluded. Patients were classified into subgroups based on risk factors and type of therapy. A multivariate model of risk was developed using clinical data and patients were classified into low, moderate and high risk. Statin prescriptions were divided into low, medium and high intensity based on US guidelines. Descriptive statistics are reported. RESULTS: Mean age of patients was 59±13 years, 47 % were women and 26 % were less than 50 years age. Diabetes was noted in 31.1 %, current smoking in 1.3 %, obesity in 14.7 % and hypothyroidism in 7.9 %. Statins were prescribed in 41.2 % (95% CI 39.4-42.9%), more in men compared to women (47.7% vs 33.7%, p<0.001). Most of the patients received moderate intensity statins (83.9%). In age-groups >40, 40-59, 60-79 and 80+ years, statins were prescribed in 18.7%, 36.5%, 49.5% and 49.4% respectively (ptrend <0.001). Statins were prescribed in 52.0% diabetics, 60.9% obese, 52.5% smokers and 34.8% hypothyroid. In the multivariate model statins use in low, medium and high risk patients was 28.4%, 46.6% and 55.1% respectively (ptrend <0.001). CONCLUSION: In an Indian secondary care practice only half of patients with moderate to high risk uncomplicated hypertension receive statins.

Assessment of obstructive airway disease in the multicenter SWORD survey India.

BACKGROUND AND OBJECTIVES: The study aimed to assess the control of asthma and the severity of chronic obstructive pulmonary disease (COPD) and evaluate the adequacy of treatment in patients presenting to the outpatient department (OPD) across India. The secondary aim was to assess the risk factors associated with poorly controlled asthma and severe COPD. MATERIALS AND METHODS: This is the analysis of Phase IV of the multicenter questionnaire-based point prevalence SWORD survey, conducted in May 2018, and designed to capture details on disease control and treatment as per the global initiative for asthma and the global initiative for chronic obstructive lung disease guidelines. RESULTS: Of the 5,311 respiratory disease patients presenting to the OPD, there were 1,419 and 412 patients with asthma and COPD, respectively, across 290 sites in India. There were 1,022 (72%) patients having well-controlled asthma, 293 (20.6%) patients with partly controlled asthma, and 104 (7.4%) patients with poorly controlled asthma. Of the 412 patients with COPD, there were 307 (74.5%) in A, 54 (13.1%) in B, and 51 (12.4%) in the E category. In spite of poor control or severe disease, 34.8% of asthmatic and 25.7% of patients in the B and E categories of COPD were not using any medicine. Risk factors for partly and poorly controlled asthma included rain wetting (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.02-2.47) and gastroesophageal reflux disease (AOR: 1.50, 95%CI: 1.08-2.10). CONCLUSION: This study identifies a gap in the treatment of both poorly controlled asthma and severe COPD. A substantial number of patients had poorly controlled asthma and severe COPD, and many were either not taking treatment or taking it inappropriately.

Low body mass index is associated with adverse cardiovascular outcomes following PCI in India: ACC-NCDR registry.

Objective: Registry-based prospective study was conducted to evaluate association of body mass index (BMI) with major adverse coronary events (MACE) following percutaneous coronary intervention (PCI). Methods: Successive patients undergoing PCI were enrolled from April'19 to March'22 and classified into five BMI categories (<23.0,23.0-24.9,25.0-26.9,27.0-29.9, and ≥30.0 kg/m2). Clinical, angiographic features, interventions and outcomes were obtained by in-person or telephonic follow-up. Primary endpoints were (a) MACE(cardiovascular deaths, acute coronary syndrome or stroke, revascularization, hospitalization and all-cause deaths) and (b)cardiovascular deaths. Cox-proportionate hazard ratios(HR) and 95 % confidence intervals(CI) were calculated. Results: The cohort included 4045 patients. Mean age was 60.3 ± 11y, 3233(79.7 %) were men. There was high prevalence of cardiometabolic risk factors. 90 % patients had acute coronary syndrome(STEMI 39.6 %, NSTEMI/unstable angina 60.3 %), 60.0 % had impaired ejection fraction(EF) and multivessel CAD. Lower BMI groups (<23.0 kg/m2) had higher prevalence of tobacco use, reduced ejection fraction(EF), multivessel CAD, stents, and less primary PCI for STEMI. There was no difference in discharge medications and in-hospital deaths. Median follow-up was 24 months (IQR 12-36), available in 3602(89.0 %). In increasing BMI categories, respectively, MACE was in 10.9,8.9,9.5,9.1 and 6.8 % (R2 = 0.73) and CVD deaths in 5.1,4.5,4.4,5.1 and 3.5 % (R2 = 0.39). Compared to lowest BMI category, age-sex adjusted HR in successive groups for MACE were 0.89,0.87,0.79,0.69 and CVD deaths 0.98,0.87,0.95,0.75 with overlapping CI. HR attenuated following multivariate adjustments. Conclusions: Low BMI patients have higher incidence of major adverse cardiovascular events following PCI in India. These patients are older, with greater tobacco use, lower EF, multivessel CAD, delayed STEMI-PCI, and longer hospitalization.

Epidemiology of cardioprotective pharmacological agent use in stable coronary heart disease.

OBJECTIVE: To determine use of class and type of cardioprotective pharmacological agents in patients with stable coronary heart disease (CHD) we performed a prescription audit. METHODS: A cross sectional survey was conducted in major districts of Rajasthan in years 2008-09. We evaluated prescription for classes (anti-platelets, ß-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and statins) and specific pharmacological agents at clinics of physicians in tertiary (n = 18), secondary (n = 69) and primary care (n = 43). Descriptive statistics are reported. RESULTS: Prescriptions of 2290 stable CHD patients were audited. Anti-platelet use was in 2031 (88.7%), ß-blockers 1494 (65.2%), ACE inhibitors 1196 (52.2%), ARBs 712 (31.1%), ACE inhibitors - ARB combinations 19 (0.8%), either ACE inhibitors or ARBs 1908 (83.3%), CCBs 1023 (44.7%), statins 1457 (63.6%) and other lipid lowering agents in 170 (7.4%). Among anti-platelets aspirin-clopidogrel combination was used in 88.5%. Top three molecules in ß-blockers were atenolol (37.8%), metoprolol (26.4%) and carvedilol (11.9%); ACE inhibitors ramipril (42.1%), lisinopril (20.3%) and perindopril (10.9%); ARB's losartan (47.7%), valsartan (22.3%) and telmisartan (14.9%); CCBs amlodipine (46.7%), diltiazem (29.1%) and verapamil (9.5%) and statins were atorvastatin (49.8%), simvastatin (28.9%) and rosuvastatin (18.3%). Use of metoprolol, ramipril, valsartan, diltiazem and atorvastatin was more at tertiary care, and atenolol, lisinopril, losartan, amlodipine and simvasatin in primary care (p < 0.01). CONCLUSIONS: There is low use of ß-blockers, ACE inhibitors, ARBs and statins in stable CHD patients among physicians in Rajasthan. Significant differences in use of specific molecules at primary, secondary and tertiary healthcare are observed.

Influence of 24-Week Yoga Intervention on Cardiovascular Risk Factors and Inflammatory Markers in Type 2 Diabetes.

Background and Aims: Persistent hyperglycemia, dyslipidemia, inflammation, and oxidative stress are important in cardiovascular risk in type-2 diabetes mellitus (DM). To evaluate the effect of 24-week yoga intervention on anthropometry and biochemical markers in DM patients, we performed a study. Methods: A hospital-based prospective randomized study in 104 participants with DM divided into control (n = 52) and intervention (n = 52) groups was performed. Patients in the intervention group performed 40 min of multifaceted individualized yoga exercises 5 days/week for 24 weeks. Anthropometric measurements and biochemical analysis were performed at baseline and after 24 weeks in both groups. Descriptive statistics are reported. Results: Baseline characteristics were similar in both groups. At 24 weeks, participants in the intervention versus controls had lower body mass index (25.6 ± 2.9 vs. 28.0 ± 3.2 kg/m2), waist-hip ratio (0.94 ± 0.06 vs. 0.99 ± 0.05), systolic blood pressure (121.2 ± 11.7 vs. 139.3 ± 19.1 mmHg), fasting glucose (142.7 ± 45.3 vs. 175.7 ± 45.4 mg/dL), glycated hemoglobin (7.2 ± 1.8 vs. 9.4 ± 1.9%), low-density lipoprotein cholesterol (167.5 ± 38.1 vs. 192.2 ± 51.4 mg/dL), nonhigh-density lipoprotein cholesterol (136.8 ± 35.3 vs. 158.6 ± 47.2 mg/dL), interleukin-6 (32.0 ± 21.5 vs. 43.5 ± 34.3 pg/mL), and high-sensitivity C-reactive protein (5.1 ± 3.7 vs. 9.5 ± 15.6 mg/L) (P ≤ 0.05). In the intervention group, higher levels of high-density lipoprotein cholesterol (49.2 ± 15.0 vs. 40.4 ± 7.2 mg/dL) and serum total antioxidants (1.9 ± 0.4 vs. 1.4 ± 0.4 mmol/L) were observed (P < 0.001). Conclusion: A short-term yoga intervention led to reduced glycemia, dyslipidemia, and inflammatory markers and increased antioxidant status in patients with type-2 DM.

Off-pump CABG surgery in left main coronary artery disease: a single-center prospective registry.

Background and objective: The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Patients with left main multi-vessel coronary artery disease (LM CAD) have concerns regarding incomplete revascularization and reduced survival with off-pump (OPCAB) when compared with on-pump (ONCAB) coronary bypass surgery. To evaluate outcomes among high-risk LM CAD patients undergoing OPCAB, we performed a registry-based prospective study. Methods: We performed 4868 coronary artery bypass graft (CABG) surgeries from Jan 2013 to Jun 2019 with 4662 (95.8%) OPCAB. In OPCAB cohort, we had 1323 patients (28.4%) with significant LM (> 50%) triple vessel CAD. Data regarding clinical features, extent of CAD, operative details, in-hospital outcomes, and 3-year follow-up were obtained. Descriptive statistics are reported. Results: The study cohort (n = 1323) was aged 63 ± 9 years with men 88.4%. Tobacco use was in 328 (24.8%), diabetes 598 (45.2%), previous myocardial infarction 463 (35.0%), previous coronary intervention 40 (3.0%), and congestive heart failure in 54 (4.1%). All patients had LM (100.0%) with triple vessel disease in 99.4% (LAD, left anterior descending 100.0%; LCX, left circumflex 99.4%; RCA, right coronary artery 78.7%). Vessels bypassed/patient were 2.7 ± 0.4 with 3.2 ± 0.7 total grafts and 2.1 ± 0.8 venous grafts. In total, 1278 (96.5%) patients received left internal mammary artery (LIMA), 63(4.7%) bilateral internal mammary artery (BIMA), and 74 (5.6%) radial artery grafts. There was no patient with conversion from OPCAB to ONCAB. In-hospital major adverse cardiovascular events (MACE: all-cause deaths, myocardial infarction, and stroke) were in 21 (1.6%). At 3-year follow-up (n = 1041), MACE rates were in 84 (8.1%) and cardiovascular deaths in 28 (2.7%). Conclusions: This study shows that off-pump CABG surgery is safe in patients with LM CAD. There is low in-hospital mortality and MACE and 3-year outcomes are similar to the published data of LM CAD patients who undergo on-pump CABG. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-023-01526-3.

Association of type 2 diabetes with coronary risk factors, clinical presentation, angiography, coronary interventions and follow-up outcomes: A single centre prospective registry.

BACKGROUND & AIMS: To determine variations in coronary artery disease (CAD) clinical presentation, interventions, and outcomes in patients with diabetes vs without, a prospective study was performed. METHODS: Successive patients with predominantly acute coronary syndromes who underwent percutaneous coronary intervention (PCI) were enrolled from January 2018 to March 2021. Patients with diabetes were compared to those without diabetes to determine differences in clinical and angiographic features and outcomes. In-person and telephonic follow-up were performed. Primary outcome was cardiovascular death and co-primary were major adverse cardiovascular events (cardiovascular death, myocardial infarction, revascularization, stroke). Cox-proportional hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS: 5181 patients (men 4139,women 1042) were enrolled. Acute coronary syndrome(ACS) was in 4917 (94.9%) and diabetes in 1987 (38.4%). Patients with diabetes were older (61.1 ± 9.6 vs 59.7 ± 11.5years), with more hypertension (71.1 vs 45.5%), chronic kidney disease (3.0 vs 1.7%), previous PCI (13.5 vs 11.0%), past coronary artery bypass graft surgery (4.9 vs 2.4%), non ST-elevation myocardial infarction (59.6 vs 51.6%) and triple vessel disease (20.3 vs 17.2%) (p < 0.01). Duration of hospitalization was more in diabetes (4.2 ± 2.6 vs 4.0 ± 2.1 days, p = 0.023) with no difference in in-hospital deaths (1.4 vs 1.0%, p = 0.197). Follow up was performed in 1202 patients (diabetes 499,41.5%) enrolled from April 2020 to March 2021 (median 16.4 months). In diabetes there were more cardiovascular deaths (multivariate adjusted HR 2.38, CI 1.13-5.02) and all-cause deaths (HR 1.85, CI 1.06-3.22). CONCLUSIONS: CAD patients with diabetes undergoing PCI have more hypertension, chronic kidney disease, non ST-elevation myocardial infarction and triple vessel disease. At medium-term follow-up the incidence of cardiovascular and all-cause deaths is significantly more in these patients.

Secondary prevention therapies for coronary heart disease in patients with type 2 diabetes: an audit.

BACKGROUND: Use of evidence based pharmacotherapy reduces risk of secondary events in patients with established coronary heart disease (CHD). To determine frequency of their use in diabetic CHD we performed prescription audits. METHODS: Frequency of prescriptions of aspirin, beta-blockers, angiotensin converting enzymes inhibitors (ACEI) or angiotensin receptor blockers (ARB), lipid-lowering medicines, and other drugs in CHD patients at primary, secondary and tertiary levels of care in out-patients' departments in Rajasthan was determined. Patients' and physicians' demographic details and prescribing patterns were obtained. Descriptive statistics are reported. RESULTS: We audited prescriptions of 2290 CHD patients aged 60.9 +/- 8.7 years. There were 1033 patients of CHD with diabetes (45.1%, age 61.9 +/- 8.6) and 1257 without (54.9%, age 59.9 +/- 8.9). In CHD patients with diabetes vs. without, use of beta blockers was lower (59.4 vs 69.2%) while ACEI/ARB (86.5 vs 82.1%) and statins (67.1 vs 59.7%) greater. Use of other drugs such as aspirin (88.7 vs 88.3%), fibrates (11.9 vs 11.1%), non-dihydropyridine CCB (16.0 vs 17.9%) and nitrates (38.8 vs 14.5%) was similar. Use of beta blockers was lowest among diabetologists (37.6%) as compared to other physicians (64.4%) and cardiologists (59.4%) and was the lowest in primary care. CONCLUSIONS: Low use of beta-blockers is observed in diabetic CHD patients.

Nephrotic syndrome leading to recurrent pulmonary embolism: A report of two cases.

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Hijacking the intrinsic vitamin B12 pathway for the oral delivery of nanoparticles, resulting in enhanced in vivo anti-leishmanial activity.

Surface-functionalized vitamin B12 (VB12) biocompatible nanoparticles exploit the well-characterized uptake pathway of VB12, shielding it from enzymatic degradation and inadequate absorption. In this perspective, subsequent to escalated mucus interaction and diffusion analysis, the nanoparticles were investigated by immunostaining with the anti-CD320 antibody, and their internalization mechanisms were examined by selectively blocking specific uptake processes. It was observed that their internalization occurred via an energy-dependent clathrin-mediated mechanism, simultaneously highlighting their remarkable ability to bypass the P-glycoprotein efflux. In particular, the synthesized nanoparticles were evaluated for their cytocompatibility by analyzing cellular proliferation, membrane viscoelasticity, and fluidity by fluorescence recovery after photobleaching and oxidative-stress detection, making them well-suited for successful translation to a clinical setup. Our previous in vitro antileishmanial results were paramount for their further in vivo and toxicity analysis, demonstrating their targeted therapeutic efficiency. The augmented surface hydrophilicity, which is attributed to VB12, and monomerization of amphotericin B in the lipid core strengthened the oral bioavailability and stability of the nanoparticles, as evidenced by the fluorescence resonance energy transfer analysis.

Proportionate clinical burden of respiratory diseases in Indian outdoor services and its relationship with seasonal transitions and risk factors: The results of SWORD survey.

BACKGROUND: The Global Burden of Disease data suggest that respiratory diseases contribute to high morbidity in India. However, the factors responsible for high morbidity are not quite clear. Therefore, the Seasonal Waves Of Respiratory Disorders (SWORD) study was planned to estimate the point prevalence due to respiratory diseases in Indian OPD services and its association with risk factors and change in seasons. METHODS: In this point prevalence observational multicenter study conducted during 2017-18, participating physicians recorded information of consecutive patients in response to a questionnaire. The study was conducted on four predetermined days representing transition of Indian seasons i.e., February (winter), May (summer), August (monsoon), and November (autumn). RESULTS: The eligible number of patients from across 302 sites in India was 25,177. The mean age of study population was 46.1±18.1 years, 14102(56.0%) were males and 11075(44.0%) females. The common diagnoses were: asthma(29.8%), chronic obstructive pulmonary disease (COPD),15.6%, respiratory tract infections (RTIs),11.3%, and tuberculosis(8.7%). All these conditions showed significant seasonal trends (Asthma 31.4% autumn vs. 26.5% summer, COPD 21.1% winter vs. 8.1% summer, RTIs 13.3% winter vs. 4.3% summer, and tuberculosis 12.5% autumn vs. 4.1% summer, p<0.001 for each respectively). After adjustment for risk factors, asthma was significantly associated with exposure to molds (OR:1.12,CI:1.03-1.22), pet animals (OR:1.07,CI:1.01-1.14), recent-travel (OR:1.22,CI:1.13-1.32), and rain-wetting (OR:1.27,CI:1.15-1.40); and RTIs with rain-wetting (OR:1.53,CI:1.34-1.74), and recent-travel (OR:1.17,CI:1.05-1.30). CONCLUSIONS: The SWORD study showed wide seasonal variations in outpatient attendance of patients with common respiratory conditions. Novel risk-factors associated with respiratory diseases were also identified.

Assessing the reliability and validity of comprehensive score for financial toxicity (COST) among radiation oncology patients in India: a cross-sectional pilot study.

BACKGROUND: Besides physical toxicity, cancer care imposes significant financial distress referred to as financial toxicity (FT). FT has become a growing concern among cancer patients. Researchers have associated FT among cancer patients with clinical outcomes like mortality, poor quality of life and non-adherence. Currently, no reliable tools are available for assessing FT among cancer patients in India. The aim of this pilot study was to test the reliability and validity of the Comprehensive Score for Financial Toxicity (COST) questionnaire among patients undergoing radiotherapy in India. MATERIAL AND METHODS: This cross-sectional pilot study was conducted among head and neck cancer patients on follow-up in radiation oncology department. The reliability of COST measure was assessed using Cronbach's α. The underlying construct of COST was verified by Exploratory Factor Analysis (EFA). EFA was performed using parallel analysis technique. RESULTS: Based on inclusion and exclusion criteria, the COST questionnaire was administered to 29 patients using the interview method after written informed consent. The COST measure demonstrated excellent reliability with Cronbach's α of 0.92. A Kaiser-Meyer-Olkin of 0.87 verified the sample adequacy and a p-value of ˂0.001on Bartlett's sphericity test indicated that the strength of the correlation between 11 COST items was good to perform the EFA. Parallel analysis technique identified one factor on scree plot with eigenvalue of 6.21 explaining 56.5% of the variance by non-rotated solution. All the factor loadings in one factor model were ˃0.3 (range 0.35-0.97). The factor loadings indicated that the underlying construct can be considered as one factor domain as intended by the original COST development study. However, Chi-square goodness of fit test revealed the one factor model did not adequately depict the data. However, the results were consistent with the construct obtained in the original scale development study. CONCLUSION: This pilot study demonstrated excellent reliability of COST for measuring FT among radiation oncology patients. Further studies are warranted to study the clinical implications of FT in the Indian population for making better strategies and policies to ease the financial burden on cancer patients.

Methodology of Seasonal Waves of Respiratory Disorders survey conducted at respiratory outpatient clinics across India.

BACKGROUND: Respiratory disorders are important contributors to disease burden across the world. The aim is to assess the proportionate burden of types of respiratory diseases and their seasonal patterns in India we are performing a field study. The present report describes methodological aspects of a respiratory disease point prevalence survey from India. METHODS: A total of 4108 chest physicians were invited. Acceptance was received from 420 sites. Chest physicians were classified according to location of practice one as medical college, district government hospital, private hospital, and private clinics. Qualifications of practicing chest physicians were postgraduate in chest medicine, including Doctorate of Medicine (68.4%), diploma in chest medicine (22.1%), and Postgraduate in Medicine (9.5%). The study questionnaire was designed to record demographic data, comorbidities, risk factors, and respiratory conditions based on ICD-10. RESULTS: A total of 366 sites provided baseline data, and the response rate of recruitment of the study sites was 8.9% in the baseline phase. However, government and private medical colleges, as well as government and private hospitals across India, were part of recruitment of respiratory patients for this survey. CONCLUSIONS: It is feasible to conduct a large multisite study to assess respiratory disease burden. Challenges include low response rate and logistic issues.

Validation of a Genome-Wide Polygenic Score for Coronary Artery Disease in South Asians.

BACKGROUND: Genome-wide polygenic scores (GPS) integrate information from many common DNA variants into a single number. Because rates of coronary artery disease (CAD) are substantially higher among South Asians, a GPS to identify high-risk individuals may be particularly useful in this population. OBJECTIVES: This analysis used summary statistics from a prior genome-wide association study to derive a new GPSCAD for South Asians. METHODS: This GPSCAD was validated in 7,244 South Asian UK Biobank participants and tested in 491 individuals from a case-control study in Bangladesh. Next, a static ancestry and GPSCAD reference distribution was built using whole-genome sequencing from 1,522 Indian individuals, and a framework was tested for projecting individuals onto this static ancestry and GPSCAD reference distribution using 1,800 CAD cases and 1,163 control subjects newly recruited in India. RESULTS: The GPSCAD, containing 6,630,150 common DNA variants, had an odds ratio (OR) per SD of 1.58 in South Asian UK Biobank participants and 1.60 in the Bangladeshi study (p < 0.001 for each). Next, individuals of the Indian case-control study were projected onto static reference distributions, observing an OR/SD of 1.66 (p < 0.001). Compared with the middle quintile, risk for CAD was most pronounced for those in the top 5% of the GPSCAD distribution-ORs of 4.16, 2.46, and 3.22 in the South Asian UK Biobank, Bangladeshi, and Indian studies, respectively (p < 0.05 for each). CONCLUSIONS: The new GPSCAD has been developed and tested using 3 distinct South Asian studies, and provides a generalizable framework for ancestry-specific GPS assessment.

Incidence of new diabetes following CABG surgery: Analysis of a single centre registry data.

BACKGROUND: About 40-50% of patients undergoing coronary artery bypass graft (CABG) surgery have diabetes. The prevalence of impaired glucose tolerance (IGT) is also high in this group, however, incidence of new diabetes following CABG surgery is unknown. OBJECTIVES: To determine incidence of new diabetes and the impact on ICU and hospital stay in patients undergoing CABG surgery in India, we performed a registry-based study. METHODS: Prospectively collected data among consecutive adult cardiac surgical patients who underwent CABG surgery at a single hospital were analyzed. Descriptive statistics are reported. RESULTS: We recruited 1559 consecutive patients (men 1355, women 204) and analyzed data among 933 non-diabetic patients. Patients with known diabetes (n = 626, 40%) were excluded. 57 (6.1%) of the 933 non-diabetic patients developed persistently high glucose levels at discharge with incidence rate of 61 + 5/1000. Patients who developed diabetes had similar age and body mass index vs those who did not, but had greater preoperative IGT (44.6 vs 13.7%) and more time-period in intensive care unit (102.0 + 75 vs 80.2 + 29 hours) as well as in hospital (11.7 + 5.7 vs 9.6 + 2.4 days) (p < 0.001). CONCLUSION: In a significant proportion of non-diabetic patients diabetes is unmasked after CABG. This is more likely in those with impaired glucose tolerance and prolonged period in intensive care and hospital.

Postprandial Hypertriglyceridemia Predicts Development of Insulin Resistance Glucose Intolerance and Type 2 Diabetes.

Insulin resistance (IR) and type 2 diabetes mellitus (T2DM) have been found to be associated with postprandial hypertriglyceridemia (PPHTg). However, whether PPHTg can cause IR and diabetes is not clear. We therefore investigated the role of PPHTg in development of T2DM in rat model of T2DM. 96 male Wistar rats were randomized into four groups (24 rats each). Control Group A, high sucrose diet (HSD) Group B, HSD+Pioglitazone (10 mg/kg/day) Group C and HSD+Atorvastatin (20 mg/kg/day) Group D. Fat and glucose tolerance tests were done at regular intervals in all groups besides insulin and body weight measurement. At 26 weeks, low dose streptozotocin (15 mg/kg, i.p.) was given to half of the rats. All rats were followed up till 48 weeks. PPHTg developed as early as week 2 in Group B and stabilized by week 14. Group B displayed highest PPHTg compared to other groups. Atorvastatin treatment (Group D) abolished PPHTg which became comparable to controls, pioglitazone treatment partially blunted PPHTg resulting in intermediate PPHTg. Group B with highest PPHTg showed highest subsequent IR, glucose intolerance (GI) and highest incidence of prediabetes at week 26 and diabetes at week 34 and 46 compared to other groups. Group D rats displayed lower IR, GI, low incidence of prediabetes and diabetes at these time points compared to Groups B and C. ROC analysis showed that triglyceride area under the curve of each time point significantly predicts the risk of diabetes. Present study provides the evidence that PPHTg predicts the development of IR, GI and T2DM in rat model of diet induced T2DM.

Apical hypertrophic cardiomyopathy with hemodynamically unstable ventricular arrhythmia - Atypical presentation.

We present a patient with asymptomatic apical hypertrophic cardiomyopathy (AHCM) who recently developed cardiac arrhythmias, and shortly discuss the diagnostic modalities, differential diagnosis, and treatment strategy for this condition. AHCM is a rare form of hypertrophic cardiomyopathy, which usually involves the apex of the left ventricle. AHCM can occur with varied presentations such as chest pain, palpitations, dyspnea, syncope, atrial fibrillation, myocardial infarction, embolic events, ventricular fibrillation, and congestive heart failure. The most peculiar electrocardiogram findings are giant T-waves inversion in the precordial leads with left ventricular (LV) hypertrophy. A transthoracic echocardiogram is the initial diagnostic modality in the evaluation of AHCM and shows hypertrophy of the LV apex. Other diagnostic modalities, including left ventriculography, multislice spiral computed tomography, and cardiac magnetic resonance imagings, are also valuable tools. Medications used to manage include verapamil, beta-blockers, and antiarrhythmic agents. An implantable cardioverter defibrillator (ICD) is recommended for high-risk patients.