Study on pattern of drug utilization in the treatment of congestive cardiac failure in a tertiary care hospital

Background: Congestive cardiac failure/congestive heart failure (CCF/CHF) is one of the major public health problem seen in more than 23 million people worldwide. Drug utilization studies were stood as a powerful exploratory tool to ascertain the role of drugs in determining the therapeutic efficacy, cost effectiveness and also in minimizing the adverse effects due to it during the treatment of a disease. Aims and Objectives: The present study undertaken to describe the drug utilization pattern in patients of CHF in a tertiary care hospital. Materials and Methods: This is a Prospective, Observational, and Non-interventional study. The study was undertaken after obtaining the ethical committee approval in the in-patient department of Medicine. Case records of 100 patients were obtained and treatments were noted. Results: The present study had 60 male and 40 female patients admitted and undergoing treatment for CCF. Most of them were above 50 years of age and the most common comorbidity among them were hypertension (25%) followed by diabetes mellitus (19%). The most commonly used drugs were diuretics and antihypertensives. Conclusion: In our study, patients use of more than 2 ?3 drugs (Polytherapy) was found very common than use of one drug (Monotherapy).

Neutrophil gelatinase-associated lipocalin: a biochemical marker for acute kidney injury and long-term outcomes in patients presenting to the emergency department

INTRODUCTION@#Creatinine has limitations in identifying and predicting acute kidney injury (AKI). Our study examined the utility of neutrophil gelatinase-associated lipocalin (NGAL) in predicting AKI in patients presenting to the emergency department (ED), and in predicting the need for renal replacement therapy (RRT), occurrence of major adverse cardiac events (MACE) and all-cause mortality at three months post visit.@*METHODS@#This is a single-centre prospective cohort study conducted at Singapore General Hospital (SGH). Patients presenting to SGH ED from July 2011 to August 2012 were recruited. They were aged ≥21 years, with an estimated glomerular filtration rate <60 mL/min/1.73 m2, and had congestive cardiac failure, systemic inflammatory response syndrome or required hospital admission. AKI was diagnosed by researchers blinded to experimental measurements. Serum NGAL was measured as a point-of-care test.@*RESULTS@#A total of 784 patients were enrolled, of whom 107 (13.6%) had AKI. Mean serum NGAL levels were raised (P < 0.001) in patients with AKI (670.0 ± 431.9 ng/dL) compared with patients without AKI (490.3 ± 391.6 ng/dL). The sensitivity and specificity of NGAL levels >490 ng/dL for AKI were 59% (95% confidence interval [CI] 49%-68%) and 65% (95% CI 61%-68%), respectively. Need for RRT increased 21% per 100 ng/dL increase in NGAL (P < 0.001), whereas odds of death in three months increased 10% per 100 ng/dL increase in NGAL (P = 0.028). No clear relationship was observed between NGAL levels and MACE.@*CONCLUSION@#Serum NGAL identifies AKI and predicts three-month mortality.

Study of etiology of pleural effusion in Telangana population

Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.

Serum Uric Acid in Acute Coronary Syndromes

Introduction: Uric acid (urate), an organic compound ofcarbon, nitrogen, oxygen and hydrogen has been thought to beprotective against ageing, oxidative stress and oxidative cellinjury owing to its oxidant property. Recent epidemiologicaland clinical evidences suggest that hyperuricaemia might be arisk factor for cardiovascular disease where enhanced oxidativestress plays an important pathophysiological role. The studyis taken up to determine serum uric acid levels in AcuteCoronary Syndromes (ACS) and to compare the incidence ofcomplications in hyperuricaemic and normouricaemic acutecoronary syndrome patients.Material and Methods: A prospective cohort study wasconducted in the Department of Medicine in collaborationwith Department of Biochemistry, RIMS, Imphal fromOctober 2014 to September 2016, among 73 normouricaemicACS patients and 73 hyperuricaemic ACS patients. Clinicaland anthropometric data were taken from each subject.Laboratory evaluation involves serum uric acid by enzymaticcolorimetric method.Results: The mean serum uric acid level in the studypopulation was 5.96 ± 1.88 mg/dl. Arrhythmias occurred in27.4% of hyperuricemic patients and 5.5% of normouricemicpatients. It is observed that 27 patients developed congestivecardiac failure (CCF), out of which 17 patients (22.3%)were hyperuricaemic and 10 patients (13.7%) werenormouricaemic. Pulmonary edema (PE) was observed in 35hyperuricaemic and 28 normouricaemic patients (47.9% and38.4% respectively).Conclusions: Complications of ACS such as arrhythmias,CCF and PE occurred more frequently in hyperuricaemicindividuals. Thus, it can be concluded that serum uric acidlevel can be considered a suitable marker for predicting ACSrelated future adverse events.

Study of cardiac disease and its outcome in pregnancy

Background: Pregnancy comes as a temporary complication in the disease process of a patient with a cardiac lesion. It is the 4th common cause of maternal mortality and one of the most important non-obstetrical causes of maternal death. Previously most women with diagnosed heart disease were advised to avoid pregnancy and labor and termination was advised. But in modern obstetrical practice, pregnancy in a patient with a heart disease is no longer an unacceptable hazard. The objective of this study is to find out incidence of cardiac diseases in pregnancy, to evaluate their management and to find out maternal and fetal outcome in pregnancy with cardiac disease.Methods: This study is a prospective cohort study in which an analysis of maternal and fetal outcome in 30 cases of cardiac diseases in pregnancy was carried out in the department of Obstetrics and Gynaecology in our institute at Civil hospital Ahmadabad from 01/01/2017 to 31/12/2017.The study included all known case of RHD, CHD, or newly diagnosed case or surgically corrected case with prosthetic heart valves during current pregnancy.Results: Majority of women having pregnancy with cardiac disease were in the age group of 20-30 years. Majority of them were primigravida and suffered from rheumatic heart diseases with grade 1 NYHA severity. Majority of women got delivered by normal vaginal delivery with healthy fetal outcome. Most of the babies born to cardiac mother had their baby weight ranging between 2.0-2.5kg.Conclusions: The results of present study indicate that heart disease forms a considerable proportion of medical illness complicating pregnancy. Cardiac disease presents problems both to the obstetrician and as well as to the physician, cardiologist and to the neonatologist. But the majority of pregnancies complicated by heart disease are uneventful with a favorably good outcome for both the mother and the fetus.

Study on clinical presentation and etiological profile of atrial fibrillation patients

Background: Atrial fibrillation is one of most common arrhythmias observed in general practice. Atrial fibrillation may occur paroxysmal or may become established as permanent condition. The aim of the treatment of atrial fibrillation is either normalization of rhythm by cardioversion or control of ventricular rate by drugs. The present work was undertaken to study, clinical presentation, aetiology and complications in patients developing atrial fibrillation.Methods: A prospective study carried out at Department of Medicine V.M. Medical college and Shri Chhatrapati Shivaji Maharaj Sarvopachar Rungnalaya, Solapur, over the study period of two years. 100 patients of atrial fibrillation diagnosed by following clinical and ECG criteria were included. Detail study of aetiology complication and clinical presentation of atrial fibrillation was done in present study.Results: Commonest presenting symptom was breathlessness (70%) followed by palpitation (58%). Common signs elicited were irregular pulse, apex pulse deficit (92%). Congestive cardiac failure was present in 46% patient among those raised JVP was seen in 100% cases, oedema in 60.8% hepatomegaly 63.04% basal crepitations in 86.9% cases. ECG revealed coarse fibrillary waves (81.8%) in patients with rheumatic heart disease whereas fine fibrillary waves were seen in patients with IHD as cause of AF.Conclusions: Size of fibrillary was may be predicted etiology of AF as coarse waves are common in rheumatic and fine waves in non- rheumatic AF. The present paper would help in early diagnosis and prompt treatment of AF.

Adult Form of Scimitar Syndrome Presenting as Severe Pulmonary Hypertension in a Child.

Background: Scimitar syndrome is a rare association of congenital cardiopulmonary anomalies; the adult form is not usually is associated with pulmonary hypertension. Case characteristics: 6-year-old girl with recurrent episodes of cough and breathlessness, along with features of right heart enlargement. Computed tomography angiogram revealed right pulmonary veins draining into inferior vena cava with dextroposition of heart. Outcome: Successfully managed with surgical correction. Message: Scimitar syndrome should be considered in any child with unexplained pulmonary hypertension and dextroposed heart.

“ADPKD presenting as congestive cardiac failure secondary to dilated cardiomyopathy” - a case report.

ADPKD presenting as congestive cardiac failure due to dilated cardiomyopathy is rare. ADPKD is an inherited systemic disorder with major renal manifestation and in some cases extrarenal manifestation or combination of both. In this report 45 year male patient presented with complains of dyspnoea, abdominal distension, pain right hypochondriac region. He was hospitalized, examined clinically and advised various bio-chemical and imaging tests. The finding was suggestive of ADPKD with dilated cardiomyopathy with congestive cardiac failure. He was managed with diuretics, ACE inhibitors, digoxin, Moist oxygen inhalation and he responded to the treatment.

Laboratory diagnostic value of COPD with congestive cardiac failure / 国际检验医学杂志

Objective To investigate the Laboratory diagnostic value of COPD with congestive cardiac failure .The clinical signif‐icance on the combined detection of the serum B‐type natriuretic peptide(BNP) ,high sensitive C reactive protein (hs‐CRP) ,and he‐moglobin(Hb) in COPD with congestive cardiac failure .Methods The serum levels of BNP ,hs‐CRP and Hb in 205 patients with different etiological factors and grades(according to the pulmonary function test Ⅰ - Ⅳ) and 100 healthy controls were determined . The sensitivity and specificity of 3 parameters were evaluated .Results The levels of BNP ,hs‐CRP ,and Hb in different grades of COPD had statistical significance(P0 .05) .The sensitivity of combined detection was 90 .2% in early COPD diagnosis ,which was higher significantly than that of the individual detection (P<0 .05) .Conclusion The significant clinical significance on the combined detection of the serum BNP ,hs‐CRP and Hb provides reference support in the diagnosis of early COPD .

Maternal and fetal outcomes in rheumatic heart disease in pregnancy.

Background: Rheumatic Heart Disease remains the most common type of heart disease in pregnancy in developing countries. Over a period of 2 years,129 pregnant patients with Rheumatic Heart Disease attending our outpatient department, were observed from admission till discharge and the clinical course during pregnancy and the maternal, foetal outcomes, and desire of future contraception studied. Methods: Patients were routinely examined every antenatal visit for signs of anemia and congestive cardiac failure. They were usually admitted at 28-32 weeks of gestation unless they presented with symptoms of cardiac failure earlier in pregnancy. Frequency of the antenatal visits depended on the functional cardiac status. Results: The incidence of heart disease was 0.96% for all deliveries during our study period. The incidence of RHD was 71.6%. 65.1% of women gave a h/o rheumatic fever. 45(34.9%) patients had undergone surgical correction and 84(65.1%) did not undergo surgical correction. 95.3% had moderate to severe disease but only 18.6% were in NYHA class III/IV. Hence severity of disease did not correlate with NHYA class. 76.7% of women had vaginal delivery. LSCS was done for obstetric reasons alone. Conclusion: The association of the pre pregnancy functional class with the risk of maternal events raises attention to the possibility of reducing these complications in pregnant women with mitral stenosis by means of early interventions aimed at improving their functional class.

Trends in drug usage among elderly with cardiovascular diseases.

Background: Cardiovascular disease (CVD) is a common health problem in the world and a major cause of premature morbidity and mortality in the elderly. Various combinations of drugs are used for the management of CVD. Hence, the present study was conducted to analyze the drug usage trends in elderly with CVDs. Methods: A retrospective cross-sectional descriptive study was conducted for a period of 6 months in an outpatient department at a tertiary care teaching hospital. The medical records of elderly (age ≥60 years) patients with CVDs were reviewed. Drug prescribed mainly for hypertension, ischemic heart disease (IHD), congestive cardiac failure (CCF) were included along with drugs used for other co-morbidities. The results were analyzed using descriptive statistics. Results: Of 234 elderly patients, 124 (53%) were males and 110 (47%) were females. Hypertension was found in 208 (88.9%) patients, 66 (28.2%) had IHD and 4 (1.7%) had CCF. Drugs used for CVDs were beta blockers (BB) (30.77%), calcium channel blockers (CCB) (39.32%), angiotensin receptor blockers (ARB) (24.36%), angiotensin converting enzyme inhibitors (ACEIs) (20.94%) and diuretics (16.67%). Nitrates were prescribed for 66 (28.20%) patients and antiplatelet agents such as aspirin and clopidogrel were prescribed in 80 (34.19%) patients. Diabetes mellitus was found in 114 (48.7%) patients, 26 (11.1%) had bronchial asthma, followed by hyperlipidemia (3.8%), arthritis (3.8%), cerebrovascular accident (1.7%), and peripheral neuropathy, retinopathy and hypothyroidism was noted in 2 (0.9%) patients each. Conclusion: Among the antihypertensive groups CCBs were the most commonly used followed by BB, ARBs and ACEIs. Among these antihypertensive agents amlodipine, losartan, atenolol and enalapril were most commonly used. Commonly used antidiabetic agents were metformin and glimepiride.

Myocardial Dysfunction Due to Hypocalcemia.

Hypocalcemia is a curable cause of myocardial dysfunction and clinical congestive cardiac failure, with only stray reports available in literature. We describe 15 infants presenting with severe left ventricular dysfunction, who were found to have hypocalcemia with or without hypomagnesemia. Vitamin D deficiency was identified as the main cause of hypocalcemia. These children improved on supplementation of vitamin D and calcium.

Clinical Observation on Treatment of Senile Chronic Congestive Heart Failure with Shenmai Injection plus Potassium Magnessium Aspartape / 国际中医中药杂志

Objective To observe curative effect of treating senile Chronic Congestive Heart Failum(CCHF)with Shenmai Inj.plus Potassium Magnesium Asparaginate.Methods 91 patients with senile CCHF were randomly recruited into a treatment group and a control group.The control group was treated with Digoxin,Hydrochiorothiazide,Spironolacmne,Captopril,and Metoprolol taken orally.The treatment group was treated with Shenmai Injection plus Potassmm Jagrnesium Aspartate besides treatments of the control group.Both groups were ordered to rest in bed and take low-salt diet and treated for one course of 14 days.Results The total effective rate of the control group was 80.0%and the total effective rate of the treatment group was 95.7%(P＜0.05).The left veiltricular ejection fraction of the treatment group was improved obviously.As compared with the control group,the treatment group has significant difference(P＜0.01).Conclusion n was safety and effective to treat senile CCHF with Shenmai Inj.plus Potassium Magnesium Asparaginate in addition to lessen digitalis toxic effect and prevent arrhythmia.