RESUMEN
Introduction: Ivabradine is a heart rate lowering agent by inhibiting Iƒ current in sinus node. It is approved for use in patients with angina and heart failure for heart rate control. Recently, the concern has grown over increased incidence of atrial fibrillation in patients treated with Ivabradine. Aims: We observed critically ill patients in the intensive care unit, treated with Ivabradine alone versus Ivabradine plus a ?-blocking agent, and compared the incidence of new-onset atrial fibrillation. Settings and Design: This was an observational, single-center study. Materials and Methods: We observed 40 patients who were divided into two groups. One group of patients was treated with Ivabradine (no other heart rate-controlling agent) and the other group was treated with Ivabradine plus a ?-blocker drug. We studied the incidence of atrial fibrillation in an observation period of 7 days in the intensive care unit along with other patient characteristics. We used appropriate analytical protocol to compare the two groups. Statistical Analysis Used: Student’s unpaired t test and Fisher’s exact probability test were applied. The value of P < 0.05 was considered statistically significant. Results: Although one patient treated with Ivabradine (and no other rate/rhythm controlling drug) had new-onset atrial fibrillation, there was no statistically significant increase in the incidence of atrial fibrillation in critically ill patients (during the observation period) treated with Ivabradine versus Ivabradine plus ?-blocker drug. Conclusion: Our preliminary research suggests the use of Ivabradine for heart rate control in critically ill patients is not associated with an increased incidence of new-onset atrial fibrillation. However, we recommend a further larger study on this subject.
RESUMEN
It is well known fact that diabetics are prone to develop infections and have increased mortality and morbidity than non-diabetics. However, the effect of diabetes mellitus on the risk of pneumonia remains uncertain. We wanted to study the aetiology, clinical features, and the outcome of pneumonia in diabetic patients. METHODSA comparative observational study was conducted in a tertiary care hospital, southern India which included 50 diabetic patients with pneumonia and 50 non-diabetic patients with pneumonia. Clinical characteristics, x-ray findings, aetiological agents, and outcome of diabetic patients were analysed and compared with data from the control group. RESULTSDiabetic patients with pneumonia were more unwell at the time of admission in the form of high PSI (Pneumonia Severity Index) score (p = 0.004**), intensive care admissions and prolonged hospital stay (p = < 0.001**). Diabetic patients were significantly associated with multilobar involvement (p = 0.045*). There was no significant difference in age, gender, coexisting underlying disease and complications. In patients with diabetes mellitus, mortality was associated with multilobar infiltrate, increased PSI score (p = 0.078*) at admission. CONCLUSIONSThese is a significant difference between pneumonia in diabetics compared with non-diabetics. Diabetic patients had presented with higher PSI score, required more ICU admissions and had prolonged hospitalization. Diabetes is also associated with bad prognosis and high mortality.