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Background: Global evidence-based recommendations for hypertension management are periodically updated, and ensuring adherence to the guidelines is imperative. Furthermore, the current high prevalence of hypertension effectuates a high health-care cost. Purpose: To evaluate the prescribing patterns of antihypertensive drugs and other factors affecting blood pressure (BP) with the objective of assessing the proportion of patients achieving the target BP and to perform a pharmacoeconomic analysis in a South Indian population. Materials and Methods: In a cross-sectional study, 650 patients previously diagnosed with hypertension and already on treatment with one or more drugs were included. A prospective interview of patients was done using a prevalidated questionnaire on various factors in BP control. Prescribing patterns and pharmacoeconomic analyses, namely, cost acquisition, cost of illness, and cost-effectiveness analyses were carried out. Results: Of 650 subjects, 257 (39.54%) achieved the target BP, while 393 (60.46%) did not. A significant association of age, occupational status, monthly family income, and area of residence in addition to physical activity and diet scores, with achieving target BP was noted. A significantly higher cost of anti-hypertensive drug treatment in achieving target BP (P = 0.02) was observed. Among patients who achieved target BP, 37.35% were on monotherapy and 48.25% on multiple drug therapy compared to 46.31% and 35.62%, respectively, in patients who did not. Average cost-effectiveness ratio were found to be Rs. 20.45 and Rs. 57.27, respectively, for single and multiple drug therapies, with incremental cost-effectiveness of Rs. 194.14 per additional patient treated with multiple free drug combinations. Conclusion: This study identified the anti-hypertensive prescribing pattern and provided insight into the various pharmacoeconomic factors that play a significant role in attaining target BP in the treated population. [ABSTRACT FROM AUTHOR]

Background:A thrombus is a healthy response to injury, intended to prevent bleeding, but can be harmful in thrombosis, when clots obstruct blood flow through healthy blood vessels. An analysis of the composition of the thrombus in STEMI patients remains an important research tool to evaluate the prognosis [mortality/morbidity] of those patients. Methods:A prospective, unicentric observational study conducted in patients presenting with STEMI from March 2017 to February 2018, at PSG Institute of Medical Sciences & Research. During percutaneous interventions thrombus was aspirated, as either red or white thrombus based on specific gross and histopathological appearance and correlate with the risk factors of ACS. Results:A total of 60 STEMI patients admitted in the study period underwent thrombectomy. The mean age of the patients were 60.5-5 years. There was no significant difference in risk factors in patients who had red thrombus and white thrombus (p>0.05). The average size of the thrombus was 0.3mm2. Total ischemic time was observed to be more in patient who had white thrombus than red thrombus. Average ischemic time for the patients were 12-5 hours. Conclusion:Our study depicted that there was no difference between red and white thrombus across ST elevated myocardial infarction patients with cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Objectives: In developing countries like India, patients with ventricular arrhythmias who were treated with antiarrhythmic drugs, in whom catheter ablation or implantable cardioverter-defibrillators (ICDs) were ineffective or contraindicated, are still obscured. Thus we aimed to evaluate the efficacy of mexiletine in patients with ventricular tachyarrhythmias/electrical storm, in whom standard treatment failed to prevent ventricular tachyarrhythmias. Methods: We performed a prospective, unicentric, observational study in patients with ventricular tachyarrhythmias treated with mexiletine in our institute from January 2019 to March 2021. The study population included all patients presented with recurrent ventricular tachyarrhythmias, with or without ICD. Results: Among the arrhythmic patients included in the study 20(80%) had monomorphic ventricual tachycardia (VT), 3(12%) had polymorphic VT and 2(8%) patients had ventricular fibrillation (VF). Patients were followed for 12 months, which showed only one patient had an episode of VT after initiating mexiletine (p<0.001). Total number of shocks and ATPs were significantly reduced compared to prior initiation of mexiletine (p<0.01 & p<0.001, respectively). Patients treated with mexiletine and both (mexiletine+amiodarone), did not have significant difference when compared to their long term efficacy. Survival analysis showed that the patients treated with mexiletine had increased survival rate compared to patients who were treated with other antiarrhythmic drugs. Conclusions: The study indicates that treatment with mexiletine may be effective and safe in patients with ICD and frequent ventricular arrhythmias and ICD shocks, regardless of the aetiology of heart disease. [ABSTRACT FROM AUTHOR]

Background: Echocardiographic evaluation is conducted as a part of routine antenatal screening in India. We conducted a study to evaluate if routine echocardiographic screening in asymptomatic patients with no self-reported symptoms and no abnormalities on clinical examination would alter the intrapartum and peripartum care. A single centre retrospective review of case records and echocardiographic images of 472 asymptomatic patients, conducted as a part of routine antenatal screening were reviewed by 2 independent cardiologists. The study excluded pregnant patients with known cardiovascular diseases (CVD) and those with clinical risk factors. Results: The rate of newly diagnosed CVD in the study was 3.6%. Acquired heart disease was found in 2.7% of the study population which comprised Rheumatic heart disease (RHD) in 0.42%, mitral valve prolapse (MVP) without mitral regurgitation (MR) in 0.84%, and MVP with MR in 1.48%. Congenital heart disease (CHD) was incidentally detected in 0.84% of patients comprising atrial septal defect (ASD), patent foramen ovale (PFO), a bicuspid aortic valve respectively, and prominent coronary sinus and persistent left superior vena cava (PLSVC). None of the patients required changes in the preexisting treatment plan, and none were recommended for termination of pregnancy or change in the mode of delivery. Conclusions: Echocardiographic evaluation of asymptomatic antenatal mothers is clinically unjustified. If CVD is diagnosed in asymptomatic mothers, it would primarily belong to the low-risk category and would not contribute to the intrapartum or peripartum care plan in any form but add to the economic burden compromising other essential antenatal care services. [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis is a microbial infection of endocardial surface of the heart and vegetation is the characteristic lesion of the disease. Mural endocarditis is a condition of rare diagnosis and may be difficult to find vegetation by standard views in transthoracic echocardiography (TTE). Identifying the mural vegetation not only helps to diagnose Infective endocarditis, but also predicts the risk for developing embolism. Aim of this study is to find the occurrence of embolism in patients with mural endocarditis. Method: A Retrospective, observational study was done for IE patients admitted from the year 2012 to 2018, in which total of 58 patients with definite diagnosis of infective endocarditis were identified. Among which 8 patients were excluded based on the exclusion criteria. Results: Total 50 patients were identified with IE, which includes 7 with mural vegetation and 43 without mural vegetation. Cultures were positive in 71.4% and 88.3% IE patients with and without mural vegetation respectively. One patient was found to have corynebacterium species with mural vegetation and embolic stroke, which is a rare occurrence. Among 43 IE patients without mural vegetation, 88.3% patients showed presence of vegetation in echocardiogram. Size of vegetation were 13 ± 6 and 14.6 ± 2.9 mm, respectively (p>0.005). All the patients with mural vegetation and 9.3% from without mural vegetation had cerebral embolic events (p < 0.005). Conclusion: Though mural vegetation is not common, but if present, it helps in diagnosis and also it may predict a propensity for embolism. Our results indicate that in patients with mural endocarditis, the propensity of embolism is more. [ABSTRACT FROM AUTHOR]