A meta-analysis of ferric carboxymaltose versus other intravenous iron preparations for the management of iron deficiency anemia during pregnancy

Abstract Objective: We conducted a meta-analysis of randomized clinical trials evaluating the clinical effects of ferric carboxymaltose therapy compared to other intravenous iron in improving hemoglobin and serum ferritin in pregnant women. We also assessed the safety of ferric carboxymaltose vs. other intravenous iron. Data source: EMBASE, PubMed, and Web of Science were searched for trials related to ferric carboxymaltose in pregnant women, published between 2005 and 2021. We also reviewed articles from google scholar. The keywords "ferric carboxymaltose," "FCM," "intravenous," "randomized," "pregnancy," "quality of life," and "neonatal outcomes" were used to search the literature. The search was limited to pregnant women. Selection of studies: Studies related to ferric carboxymaltose in pregnancy were scanned. Observational studies, review articles, and case reports were excluded. Randomized studies in pregnant women involving ferric carboxymaltose and other intravenous iron formulations were shortlisted. Of 256 studies, nine randomized control trials were selected. Data collection: Two reviewers independently extracted data from nine selected trials Data synthesis: The final effect size for increase in hemoglobin after treatment was significant for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 0.89g/dl [95% confidence interval 0.27,1.51]). The final effect size for the increase in ferritin after treatment was more for ferric carboxymaltose vs. iron sucrose/iron polymaltose (standard mean difference 22.53µg/L [-7.26, 52.33]). No serious adverse events were reported with ferric carboxymaltose or other intravenous iron. Conclusion: Ferric carboxymaltose demonstrated better efficacy than other intravenous iron in increasing hemoglobin and ferritin levels in treating iron deficiency anemia in pregnant women.

Real-world utilization pattern of dydrogesterone in 7287 Indian women with obstetric and gynecological conditions: data from multicentric, retrospective study

Abstract Objective: Despite the literature on dydrogesterone, studies on dydrogesterone utilization patterns are largely lacking in Indian patients. Methods: This was a multi-center, retrospective, observational, cross-sectional, and descriptive study across 817 centers in India. Data of patients who received dydrogesterone in past and provided consent for future use of their medical record for research purpose was were retrieved and analyzed. Results: Data of 7287 subjects (aged 29.55±4.84 years) was analyzed. Threatened abortion was the most common indication for which the subjects received dydrogesterone (46.9%) followed by recurrent pregnancy loss. Polycystic ovary syndrome (PCOS), thyroid disorders and anemia were the most common comorbid conditions and prior pregnancy loss, advanced maternal age and obesity were the most common risk factors seen in subjects who received dydrogesterone. Total 27.5% of subjects received a loading dose of dydrogesterone, and majority (64%) received 40 mg as loading dose. 10 mg dose was used as maintenance or regular dose in 81.4% of the subjects. Twice daily (BID) was the most common dosing frequency (66.6%). The most common concomitant medications being taken by the subjects on dydrogesterone included folic acid (45.1%), iron supplements (30.3%) and calcium and vitamin D3 supplements (25.5%). Another progesterone preparation (oral, injection, vaginal, tubal) other than dydrogesterone was used concurrently in 7.8% of subjects. Conclusion: The study helped to identify the patient population that is benefitted by dydrogesterone and the preferred indications, risk factors, comorbid conditions and concomitant medication used in this patient population at real-life scenario.

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).

Role of Iron Therapy in Heart Failure: A Consensus Statement from India

Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.

Parenteral Iron in Heart Failure: An Indian Perspective

Patients suffering from end stage renal disease (ESRD) often present to the emergency with breathlessness, mostly due to fluid overload. We report a rare case of recurrent unilateral massive pleural effusion in an ESRD patient on maintenance hemodialysis (MHD). The patient was on MHD thrice weekly for the last 2 years with right internal jugular vein (IJV) tunneled cuffed catheter (TCC). Chylothorax was identified as the cause of recurrent pleural effusion which was due to superior vena cava stenosis (SVCO). It was managed successfully by balloon venoplasty of SVC and anticoagulation. SVCO is a rare but a serious complication in patients on long term indwelling dialysis catheters. Physicians involved in the care of dialysis patients must be aware about complications of long term dialysis catheters like central vein stenosis. A strong suspicion of chylothorax should be reserved for a patient with recurrent unilateral pleural effusion and long term dialysis catheters.

Escitalopram Usage Pattern in India: A Knowledge, Attitude and Practice Survey among Indian Psychiatrists.

Introduction: Escitalopram is a popular and commonly prescribed anti-depressant in routine clinical practice in India. The objective of this survey was to explore knowledge, attitude and practice (KAP) of escitalopram usage pattern in routine clinical practice amongst Indian psychiatrists. Methodology: Total 280 psychiatrists across India were surveyed and KAP were evaluated. Twelve questions which explored indications, dosages, duration, efficacy, tolerability and comparison were asked and results were expressed as percentages. Results: Major depressive disorder and anxiety disorder were found to be the common indications along with Post-Traumatic Stress Disorder (PTSD) and Obsessive Compulsive Disorder (OCD). Escitalopram was reported to be used mostly at 10 mg dosage for 6-12 months. Escitalopram was found to be preferred in the elderly and in patients with cardiac diseases. Weight gain, gastrointestinal intolerance and sexual disturbances were commonly reported with the latter often leading to discontinuation. However, the tolerability compared to other Selective Serotonin Receptor Inhibitors (SSRIs) was reported to be good to excellent. Some of the adverse effects reported were weight gain, sexual disturbances and gastrointestinal intolerance. Conclusion: The present KAP survey highlights that escitalopram’s effectiveness and tolerability are valued by many Indian psychiatrists to be good to excellent and account for its robust clinical utility.

Survival pattern of reported HIV infected individuals in the city of Delhi (India).

There is very little data on the survival period of HIV in India. In this paper survival experience of 836 HIV infected patients was studied whose illness was diagnosed upto Dec. 2003. On analysis, it was observed that the mortality was maximum in the age-group of 41-50 years (25%), 24.4% in males and 24.2% in females. For patients with tuberculosis morality was 23% and was higher among those with unsafe sex (24.5%) as a risk factor. Mortality of AIDS patients in Delhi decreased from 63.2% in 1994 to 24.2% in the year 2003. Also tuberculosis was found to be the major opportunistic infection affecting 83.2% of the patients. An increasing trend was observed with tuberculosis from 84.2% in 1994 to 89.1% in 1997 (p<0.05), but overall tendency was around 84% during the period 1994 to 2003. In AIDS related symptoms chronic diarrheoa accounted for only 5.2%. The median length of survival of HIV infected patients with all subjects was 75 months. The hazard rate showed an increasing trend and reached its peak at 102 months. The survival of HIV infected patients in Delhi was found to be shorter than that of patients in developed countries and developing African countries.