Patient profile based management approach for Optimal Treatment of Angina: a consensus from India cases

Chronic stable angina (CSA) is an incapacitating disorder. The pain can hinder the routine chores of an individual and significantly impact one’s quality of life (QoL). However, the good news is that this can be treated and the QoL can be improved. The key to apt management lies in the accurate early diagnosis of this condition, followed by a detailed evaluation and accordingly planned management, which should be regularly revised and be backed by an adequate follow-up. OPTA-OPtimal Treatment for chronic stable Angina-is an educational initiative to assist the clinicians in India with screening and diagnostic tools, strengthened by updated guideline-directed management to ensure satisfactory patient outcomes. OPTA aims to improve clinical outcomes by providing optimized pharmacotherapy for patients with stable angina. This expert consensus document intends to provide information for better understanding of the condition by clinicians and to ensure an early, accurate diagnosis, followed by optimal management of angina. For better clinical and practical understanding of Indian clinical scenario, the most commonly encountered patient profiles are briefly described here. These inputs and an extensive literature review were blended to develop the recommendations for clinicians across the country. An attempt is made to include clinical recommendations that meet the needs of the majority of patients in most circumstances in the Indian scenario. However, the ultimate judgment regarding individual case management should be based on clinician’s discretion. This expert consensus document is not a substitute for textbooks and/or a clinical judgment.

Adaptation of 2016 European Society of Cardiology/European Atherosclerosis Society guideline for lipid management to Indian patients – A consensus document

In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia.

Effect of Partial Sleep Deprivation on Auditory Event Related Potential and Reaction Time in Medical Students.

The aim of the present study was to evaluate the effects of partial sleep deprivation on the cognitive status and alertness of medical students using auditory event related potential (ERP) and auditory reaction time (RT) using sleep questionnaire, Stanford Sleepiness Scale (SSS), auditory ERP (P300) and RT. Sleep time was significantly shorter in the test condition as compared to the baseline values (p<0.001). Significantly higher values on the SSS (p<0.05) were found after sleep restriction. The P300 latency and amplitude significantly decreased (p<0.01 and p<0.001 respectively) when the test values were compared to the baseline. RT also showed a significant decrease (p<0.001) in the test condition as compared to the baseline values. However, no significant correlation could be ascertained between SSS and P300 amplitude and latency as well as RT. This study demonstrates that partial sleep deprivation produces variable effects on the cognitive status of medical students as reflected by the decrease in P300 amplitude and latency. Alertness of medical students seemed to show an improvement as reflected by the decrease in RT.

A case-control study of risk factors for coronary heart disease in urban Indian middle-aged males.

OBJECTIVE: There are few case-control studies on native Indians to explore the reasons for the growing prevalence of coronary heart disease (CHD) in Indians. The present study was undertaken to identify the conventional coronary risk factors in angiographically proven CHD cases by comparing their prevalence in age-and gender-matched healthy controls. METHODOLOGY: A hospital-based case-control study was performed on 197 middle-aged urban males (age 40-64 years) with angiographically proven CHD and 197 age (32 years) and gender-matched healthy controls in a tertiary cardiac care center of New Delhi. Prevalence of coronary risk factors with special emphasis on diet was determined by administration of a pre-tested questionnaire, physical examination, and biochemical estimation of blood lipids and glucose. Odds ratios (OR) and their 95% confidence intervals (CI) for the association of risk factors with CHD and their population attributable risks (PAR) were calculated. RESULTS: Logistic regression analysis showed that history of diabetes mellitus (OR 4.934, 95% CI 2.320-10.494), low education (OR 2.410, 95% CI 1.261-4.608), full cream milk consumption (OR 2.113 95% CI 1.176-3.798), and family history of premature cardiovascular disease (CVD) (OR 1.810, 95% CI 1.064-3.079) were independent risk factors for CHD. High HDL-C (OR 1.055 95% CI 1.025-1.086) and fruit intake (OR 1.473, 95% CI 1.020-2.128) emerged as anti-risk factors. 44.1% of PAR was attributable to low HDL-C (.3%), low education status (6.6%), history of diabetes mellitus (6.0%), family history of premature CVD (4.4%), low fruit consumption (4.3%), tobacco abuse (4.2%), full cream milk consumption (3.6%) or milk intake (3.4%), high fasting blood glucose (2.3%), and history of hypertension (2.07 percent;). CONCLUSIONS: Conventional risk factors are not enough to explain the high prevalence of CHD among native Indians. While efforts must go on to reduce the risk attributable to them, the role of emerging risk factors should be investigated.

Recent landmark trials in cardiology.

This section outlines various recent ongoing /completed trials on use of amiodarone, beta blockers, clopidogrel antiplatelet agents, cardiac resynchronization therapy and drug-eluting stents in management of cardiac complications and morbidity.

Recent landmark trials in cardiology.

A few recent clinical trials in the areas of acute myocardial infraction/acute coronary syndrome, implantable cardiovertordefibrillator, heart failure, and percutaneous coronary intervention vs. coronary artery bypass graft for multivessel coronary artery disease are presented here.

Effect of sodium citrate ingestion on oxygen debt & exercise endurance during supramaximal exercise.

BACKGROUND & OBJECTIVES: Administration of alkalinizing agents has been shown to improve performance in high intensity exercise. The present investigation was undertaken to determine whether sodium citrate ingestion enhances supramaximal endurance performance on a cycle ergometer and to assess its effect on oxygen debt incurred for the same supramaximal energy output. METHODS: Ten untrained, healthy, males performed acute intense bicycle ergometry exercise in two sessions viz., without (control) and with sodium citrate ingestion (experimental) in a dose of 0.5 g/kg body weight. Pre-exercise O2 consumption, pulse rate (PR) and respiratory rate (RR)/minute were recorded before both sessions. Exhaustion time (ET) was noted and work done calculated in the control session. Post-exercise PR and RR/min were also recorded in both sessions of study. Venous blood samples were drawn post-exercise and analysed for pH and lactate. O2 debt incurred was calculated in both sessions. RESULTS: Work output in supramaximal exercise averaged 69.40 +/- 15.31 Watts in the control session. None of the subjects in the experimental session complained of fatigue even when the exhaustion time noted in the control session was reached. Post-exercise tachycardia and tachypnoea were both significantly less (P<0.05 and P<0.001 respectively) in subjects after the experimental session as compared to the control. O2 debt incurred and lowering of blood pH were also significantly less (P<0.001) in the post-citrate phase. However, serum lactate increased significantly (P<0.05) in subjects after the experimental session. INTERPRETATION & CONCLUSION: Ingestion of sodium citrate prior to supramaximal exercise resulted in a reduction in post exercise O2 debt incurred. Blood pH was almost normal despite a higher serum lactate concentration. This probably led to an enhancement in exercise performance.