Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India

Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).

Comparative study of efficacy and safety of garenoxacin and moxifloxacin in acute exacerbation of chronic bronchitis in COPD patients

Background: Acute exacerbation of chronic bronchitis in COPD (AECB) is the major cause of morbidity, mortality and marked reduction in quality of life and imposes significant burden on both patients and healthcare systems. Bacterial infections causing AECB frequently require antibacterial treatment, so more evidences are needed to guide better antibiotic choice. Objective of the study was planned to compare efficacy and safety of Garenoxacin, a new fluoroquinolone versus moxifloxacin for treatment of Acute exacerbation of Chronic bronchitis in COPD patient.Methods: This was a prospective open label comparative study done in department of pharmacology and T.B & Chest of Government Medical College attached Dr Shusila Tiwari Hospital, Haldwani. 60 subjects with clinical symptoms suggestive of Anthonisen type II AECOPD (any two of following criteria: Increased dyspnea, cough, sputum purulence) were enrolled and randomized to receive either Moxifloxacin 400 mg once daily for 7 days or Garenoxacin 400mg once daily for 7 days. The primary outcome measure was clinical success rate at day 7 visit. Secondary outcome measures were changes in clinical global impression (CGI) scales and incidence of adverse events.Results: The mean age of patient was 60.98±9.9 years and 57.9±9.3 years in the Moxifloxacin and Garenoxacin groups. The clinical success rates were comparable with 86.2% in moxifloxacin group 84.6% and in garenoxacin group. Adverse effects were mild and self limiting. We observed two adverse effects in garenoxacin and three in moxifloxacin group.Conclusions: The result of study showed that garenoxacin is comparable to moxifloxacin in terms of efficacy and safety.

Errors in drug labeling and medico-legal awareness.

The importance of drug labels can not be overlooked. Many a times drug labels are missing which may lead to toxicological effects catastrophic accident and medico -legal implication. The objective of the present study was to learn and highlight the problems faced by the medical practitioner, pharmacist and the patients as regards to drug label it’s, medico- legal problems and suggest remedial measures. 55 medical practitioner of Government Medical College, Haldwani and 40 pharmacist of Haldwani town were surveyed through a questionnaire. The 90% of medical practitioners and 80% of pharmacist had faced problem with label related errors. None had been charged for malpraxis and negligence. Remedial measures suggested were barcoding (96%, 60%) colour coding, prefilled syringes (90%, 30%), increasing font sizes and more awareness about medico-legal liability, ethical issue and punishment. Drug label errors are an important cause of patient morbidity, mortality and medico-legal liabilities of medical practitioners. Improved and correct labeling understanding medico-legal importance and communication is the key element in minimising errors. Bar code generated labels, embossing, waterproof labels, improving quality of stickers, increasing font sizes, overcoming language barriers and sense of responsibility will readdress these deficiencies in services.

Novel ideas and approaches to learning medical sciences.

Medicine is a progressive discipline for medical students who are going to be future doctors. Therefore to determine the opinion of students regarding the 2nd Professional M.B.B.S. subject, teaching methodology, reforms to be introduced, computer and Internet use and its application in teaching learning process this study was done. 475 students were given a questionnaire which consisted of 2-5 options. Questionnaire consisted of 2 parts. First part was about demographic characteristic, second part was about the subject 465 students in the age group 19-24 yr with male female ration 1:1, mostly from northern India were included in the study. Forensic Medicine emerged as the favorite subject followed by Pharmacology, Pathology and Microbiology. 40.86% (190) wanted more of clinically oriented classes, problem based learning and use of audiovisual aids. 72.04% (335) wanted integrated teaching curriculum. So in our opinion we can adopt a curriculum which is clinically oriented, integrated, revised pattern with computer application and internet use. This will make the teaching learning process in the medical sciences more effective and relevant to the health of the society.

Acute myocardial infarction due to blunt chest trauma.

We report a case of blunt chest injury following a road accident leading to damage of the left main and left anterior descending coronary arteries causing acute myocardial infarction in a young person.