Real World Evidence of Bempedoic Acid on Efficacy and Safety in Patients with Uncontrolled LDL-c and at High Risk of CVD

Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings. Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points. Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24. Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.

Development of a reference equation for maximal exercise capacity in normal Indian subjects using cardiopulmonary exercise testing

Objectives: Cardiopulmonary exercise testing (CPET) is an integrative assessment of multiple interdependent variables contributing to exercise response. CPET parameters such as maximum or peak oxygen uptake (VO2max/peak) are used to estimate this response. VO2max/peak varies with physiological predictors such as age, sex, body mass index (BMI), and activity level. The existing normative values for Indian subjects have, thus, far been adapted from Western populations who have a different body habitus in terms of these physiological predictors. We aimed to determine the relation and a prediction equation of these variables with VO2peak. Materials and Method: One hundred and twenty-one healthy subjects underwent CPET on a treadmill (Cortex Metalyzer) in a tertiary care hospital and VO2peak was calculated through Metasoft software. Statistical analysis: Student’s t-test and one-way analysis of variance (ANOVA) were used for calculating the between-group difference. Logistic regression with univariate and multivariate ANOVA was used for computing the reference equation. Results: Mean VO2peak (ml/min/kg) was 29.9 ± 7.7. It was higher for males (32.81 ± 7.9 vs. 26.79 ± 6.1 [P < 0.001]) and active individuals (32.8 ± 7 vs. 26.1 ± 6.9 [P < 0.001]). Higher values were observed in younger and non-obese population (P < 0.001). Regression coefficient (r2) was 0.44 and 0.36 for male and female, respectively. Reference equation was then calculated for males and females using the r2 value. Conclusion: VO2peak was higher in males and active individuals, it declined with increasing age and BMI. The values obtained were much lower than the Western population, therefore stressing the need for the development of our own set of reference equations.

Polycystic ovarian syndrome (PCOS): Approach to traditional systems, natural and bio-chemical compounds for its management

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder which is characterized by chronic anovulation. Irregular periods, hirsutism, weight gain are the other signs of PCOS. The prevalence of PCOS worldwide is between 6% and 26% while in India it was 3.7% to 22.5%. PCOS is the most prevailing female endocrine disorder and the preeminent cause of infertility. Risk factors that contribute to the development of PCOS include genetics, neuroendocrine system, sedentary lifestyle, diet, and obesity. Modern medicine has found many ways to heal. Synthetic drugs such as metformin and oral contraceptive pills were available in the market, but because of their side effects, people depend on traditional and herbal medicines. This review provides a detailed approach to different types of traditional and natural systems for the treatment and management of PCOS. Different approaches to managing PCOS include the traditional system of drugs, herbal remedies, herbs, and Phyto-ingredients that have proven their potential in treating PCOS. Traditional medicine includes Unani, Ayurveda, Siddha, naturopathy, yoga, and homeopathy. In addition to treatment, yoga also has potential in treating PCOS.

Incisional Hernia: A Comprehensive Study on the Incidence and Management of Abdominal Incisional Hernia

Background and objectives: Incisional hernia is the one true iatrogenic hernia. The Incisional hernia occurs in less than 5-11% of patients subjected to abdominal operation. Incisional hernia usually starts within few months after surgery, as a result of failure of the lines of closure of the abdominal wall following laparotomy. If left unattended they tend to attain large size and cause discomfort to the patient. This study has been undertaken to assess the magnitude of this problem, various factors leading to development of this condition and the different modalities of treatment practiced in our set up. Methodology: The present study was conducted at the Department of General Surgery; AMC MET Medical college and Seth L. G. Hospital Ahmedabad, in which 60 patients of incisional hernia were treated during June 2018 to April 2020. Interpretation and Conclusion: Successful repair relies on knowledge of the dynamics of the abdominal wall, thorough technical execution, appropriate selection of synthetic or bioprosthetic material, and constitution of surgical team. Though laparoscopic repair has been demonstrated to be safe and a more resilient repair than open repair, open mesh repair remains a suitable alternative.

Mephentermine Dependence: Emerging Trend of Substance Abuse and its Challenges

Dependence on Mephentermine, a widely used sympathomimetic pressor agent, is so far not extensively reported. In current report, we describe a male patient consuming extraordinary high amount of Mephentermine who developed psychosis which was successfully treated but relapsed after 5 months. In this background we also tried to highlight this trend of shift from more traditional drugs to new synthetic ones and look into the magnitude of the problem and challenges that lie ahead of us.

Idiopathic epilepsies - A population based epidemiologic study.

Background: There are only few epidemiological studies regarding epilepsy from this region. The classification of epilepsies has not been adequately stressed in these studies. Objective: To assess the occurrence of idiopathic epilepsies in Punjab (A region situated in the Indo-Gagentic Plains), India. Methods: A door to door, cross - sectional epidemiological survey covering an entire 103693 population residing in 74 contiguous villages situated outside the municipal limits of the District Headquarter town. Survey of all houses was done by general village level workers following which detailed case work up was done by postgraduate physicians. Final case identification was done by neurologists. Results: Active epilepsy (n = 795) and inactive epilepsy (n = 128) comprised 74.78 % and 12.04 % of total number of seizure cases (n = 1063) and 86.13 % and 13.87 % of all epilepsy cases (n = 923) respectively. Non epileptic conditions comprised 11.74 % of total number of seizure cases (n = 1063). Single and febrile seizures were predominant among the non epileptic conditions being 6.2 % and 3.57 % of total number of seizure cases (n = 1063). Active epilepsy cases (n = 795) included electroclinical syndromes and constellations (n = 117, 14.72 %), symptomatic (n = 153, 19.24 %) and probably symptomatic cases (n = 513, 64.53 %) and cases with dual diagnosis (n = 12, 1.51 %). Idiopathic epilepsies (n = 112) consisted of idiopathic generalized epilepsies (n = 111) and benign childhood epilepsy (n = 1). Juvenile myoclonic epilepsy (n = 42) predominated idiopathic generalized epilepsy cases (n = 111). Conclusions: Use of different terminology, definitions and criteria for diagnosis of various types of epilepsy precludes comparison between this study and other studies. This study showed significant variation in juvenile myoclonic epilepsy cases regarding sex distribution, diurnal variation and precipitating factors as compared to other studies. These differences need further confirmation.

Intraluminal Plexiform Unicystic Ameloblastoma: A Report of a Rarity in an 8-year-old Boy.

Unicystic ameloblastoma (UA) is a variant of ameloblastoma and this entity is more common in second to third decade of life. It is very rare in children with <2.2% under the age of 10 years. Th is odontogenic tumor is most commonly encountered in the posterior mandible and is associated with an impacted tooth. Th e term plexiform UA refers to a pattern of epithelial proliferation that has been described in cystic lesions of the jaws. Here is a report of a rare case of intraluminal plexiform UA, in the right posterior mandible of an 8-year-old boy presented to our department.

Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: A single center experience in a developing economy.

Background: The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world. Objective: We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution. Methods: The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection. Results: The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-‑hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance. Conclusions: The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

Same day sputum smear microscopy approach with modified ZN staining for the diagnosis of pulmonary tuberculosis in a microscopy centre at Rajahmundry.

Background: Sputum smear microscopy is the main‑stay in the diagnosis of pulmonary tuberculosis in many developing countries. To overcome the drop outs, same day diagnosis is ideal. Materials and Methods: In the current study, two spot sputum samples (SS2 approach) are collected within a gap of one hour (same day sputum smear microscopy) in addition to the standard spot morning (SM) approach. The smears were stained with standard Ziehl Neelsen (ZN) and modified ZN staining techniques. Results: Out of 1537 patients, sputum smear positivity (SSP) was 9.43% (146 patients) in SM approach with standard ZN staining. Smear positivity was increased to 9.8% (151 patients) with modified ZN staining. For SS2 approach, SSP was 9.37% (144 patients) and 9.8% (151 patients) with standard and modified ZN staining procedures, respectively. Conclusions: Diagnosis of lung tuberculosis is possible with two spot sputum samples with modified ZN staining.

Delayed syndrome in carbon monoxide poisoning.

Acute carbon monoxide poisoning can lead to delayed manifestations. This has been called post-interval syndrome, which can present after an apparent period of normalcy following acute poisoning. We are reporting a patient who had an accidental exposure to carbon monoxide and presented later with all the manifestations of delayed poisoning. The various clinical manifestations and imaging findings are discussed. A delay in recognition in the acute stage can predispose to development of the post-interval syndrome.

Late postpartum eclampsia without prodroma.

Late postpartum eclampsia is an increasingly recognized entity. We describe a patient who developed postpartum eclampsia on the 6th day of delivery without any preceding pre-eclampsia. A high index of suspicion and close follow-up will help in the early detection of this condition. Awareness of this condition will also save the patient from unnecessary investigations. This may be all the more relevant in developing countries where eclampsia contributes to one-third of maternal mortality and the resources for patient investigation and management are limited.

Primary plasma cell leukemia occuring in the young.

Plasma Cell Leukemia (PCL) is a rare form of plasma cell dyscrasia. Plasma cell leukemia has two variants: the primary form presents de novo in patients with no previous history of multiple myeloma (MM); the secondary form consists of a leukemic transformation in a previously recognized MM. In contrast to myeloma, PCL has an aggressive course. Median age at presentation is usually above 50 years. Here we report a case of primary PCL presenting at age of 21 years, which is extremely rare. She was treated with combination chemotherapy (VAD). Although she had a good response initially, later the disease progressed and she died 6 months after the diagnosis.

Gottron's syndrome.

An 18-year-old man presented with erythematous hyperkcratotic plaques symmetrically distributed on the extremities of 12 years duration. Histopathology confirmed the clinical diagnosis of symmetrical progressive erythrokeratoderma.

Succinate oxidase and fumarate reductase systems of filarial parasite Setaria digitata.

Activities of succinate oxidase, fumarate reductase (FR) and succinate dehydrogenase (SDH) under a set of defined conditions were determined in the mitochondrial isolate from Setaria digitata, the filarial parasite from the cattle Bos indicus. Presence of only two activities namely SDH and succinate--UQ reductase of the succinate oxidase system could be detected in S. digitata. In the absence of cytochromes, the 3rd enzyme of the complex namely cytochrome oxidase is absent and it is proposed that an alternative oxidase is responsible for completing the succinate oxidation expressed as succinate oxidase activity. Though SDH and FR catalyse reverse reactions, they responded differently to modulators such as oxaloacetate, aspartate, alanine, pyruvate and fumarate. The degree of response of the two activities against inhibitors of electron transport was also different. Interestingly fumarate caused only 50% inhibition of succinate oxidation, while the effect against FR was more convincing.

Immune response of electroeluted detergent soluble 29 kDa antigen from Setaria digitata (Von Linstow).

Filariasis is one of the typical parasitic infections which cause immune suppression during the course of infection in both humans and experimental animals. A 29 kDa protein isolated from detergent soluble antigen of S. digitata showed maximum inhibition of cell mediated immune response. The heat inactivated 29 kDa protein was found to be devoid of property of suppression of immune response in the host. Histological study of spleen of BALB/C mice immunized with 29 kDa protein showed changes in regions of spleen such as follicle, trabeculae, capsule, reticuloendothelial cells and eosinophils. The 29 kDa protein, the most reactive of the detergent soluble proteins produced partial suppression of immune response, thereby contributing to the factors responsible for the survival of filarial parasites in hosts.

Partial characterization of affinity purified excretory-secretory protease from Setaria digitata.

Excretory-secretory protease of S. digitata released along with the microfilariae (mf) during hatching has been purified by affinity chromatography. No other activity could be detected in the affinity purified material. Homogeneity is checked by native PAGE. It has a pH optimum of 5.4 and a molecular weight of 70 kD. The purified material showed positivity against antibodies raised against ES material.