Comparison of diltiazem and metoprolol for atrial fibrillation with rapid ventricular rate: Systematic review and meta-analysis

Background: Intravenous calcium channel blockers or beta-blockers are the preferred rate control medications for hemodynamically stable patients with atrial fibrillation with rapid ventricular rate (AFRVR) in the emergency department. Objectives: To compare the efficacy of intravenous diltiazem and metoprolol for rate control and safety with respect to development of hypotension and bradycardia in patients with AF-RVR. Methods: For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane databases, and the clinicaltrials.gov registry between database inception and 30th May 2021. Articles were included if they compared efficacy and safety of diltiazem versus metoprolol in critically ill adult patients hospitalized with AF-RVR. Outcome measures were achievement of rate control, development of new hypotension, and bradycardia after drug administration. Results: Of 86 records identified, 14 were eligible, all of which had a low to moderate risk of overall bias. The meta-analysis (Mantel-Haenszel, random-effects model) showed that diltiazem use was associated with increased achievement of rate control target compared to metoprolol [14 studies, n ¼ 1732, Odds Ratio (OR): 1.92; 95% Confidence Intervals (CI):1.26 to 2.90; I2 ¼ 61%]. In the pooled analysis, no differences were seen in hypotension using diltiazem vs metoprolol [12 studies, n ¼ 1477, OR: 0.96; 95% CI:0.61 to 1.52; I2 ¼ 35%] or bradycardia [9 studies, n ¼ 1203, OR: 2.44; 95% CI: 0.82 to 7.31; I2 ¼ 48%]. Conclusions: Intravenous diltiazem is associated with increased achievement of rate control target in patients with AF-RVR compared to metoprolol, while both medications are associated with similar incidence of hypotension and bradycardia.

Correlation of Quick SOFA Score and Procalcitonin with Mortality in the Emergency Department

Introduction:Sepsis is defined as life threatening organ dysfunction caused by the dysregulated host response to infection with high mortality. Methods:We studied 2031 patients presenting to an emergency department with fever or suspected infection to find the correlation between q SOFA SCORE and procalcitonin level swith mortality.

Metabolic Risk Factors and Outcomes in Acute Coronary Syndrome

Introduction:CAD is the most common cause of mortality in India. It is a common multifarious public health crisis today and a leading cause of morbidity and mortality in both developing and developed countries. Hence, understanding the predominant risk factors among the Indian population is important.Materials and Methods:This was a hospital based age and sex matched case control study, carried out at Government Medical College and Rajindra Hospital Patiala.A total of 100 patients ofAcute coronary syndrome were studied. Patients and controls were enquired about the presence of cardiometabolic risk factors and the significance of association of these risk factors with the occurrence of Acute coronary syndrome was given by p value of <0.05.Results: Majority of the cases were in the age group 61-70 years (32%) with male to female ratio of 1.25:1. Significant association was found between ACS and risk factors like smoking, positive family history of IHD, hypertension,diabetes, dyslipidemia, waist hip ratio and body mass index Overall, most common outcome of ACS in the present study was NSTEMI (45%) followed by STEMI (35%) followed by Unstable angina (20%).Conclusion:Significant association was found between smoking and occurrence of STEMI and significant association was found between Hypertension and occurrence of NSTEMI

Unaccustomed exertion and opiate consumption leading to acute renal failure in a healthy male.

A 38 year old male presented with stupor and acute renal failure (ARF) following opium consumption and a protracted excursion on foot to a holy shrine situated at altitude of 4329 m above sea level. The finding of dark colored urine, myoglobinuria and a markedly elevated serum creatinine phosphokinase level supported the diagnosis of rhabdomyolysis. The patient had a rapid and complete recovery following fluid resuscitation and haemodialysis.