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Objective: To compare the safety and efficacy of valsartan/sacubitril (angiotensin receptor neprilysin inhibitor [ARNI]) against enalapril (angiotensin-converting enzyme inhibitor [ACEI]) in patients with acute heart failure at 6-month follow-up. Methods: In this prospective, single centre, and observational study conducted between September 2017 and February 2020 in India, patients with acute decompensated heart failure with reduced ejection fraction (<40%) were included. Patients were divided in two groups: valsartan/sacubitril (ARNI) group and enalapril (ACEI). Patients were followed up for at least 6 months after administration of first dose and were evaluated for safety, efficacy, and tolerability of target drug. Student's independent t-test was employed for comparing continuous variables. Chi-square test or Fisher's exact test, whichever appropriate, was applied for comparing categorical variables. Results: A total of 200 patients were included in the present study, 100 each in ARNI and ACEI group. The mean age of the population was 61.2 ± 8.4 years and 62.6 ± 8.6 years in ARNI group and ACEI group, respectively. The mean maximum tolerated dose by population in ARNI group was 203.6 mg and 8.9 mg in ACEI group. Readmission for heart failure were seen significantly higher in ACEI group than ARNI group (p value ¼ 0.001). Parameters like ejection fraction, left ventricular end diastolic and systolic dimensions, 6 min walk test and Kansas City Cardiomyopathy Questionnaires (KCCQ) showed p values < 0.05 between the groups. Conclusion: The ARNI study group showed better safety and efficacy outcomes at the end of 6 months follow-up compared to ACEI group
RESUMO
Background: Congenital heart disease is one of the major causes of mortality and morbidity in the paediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of Indian subcontinent and rest of the world could be because of genetic, cultural, and environmental factors. The objective of the study was to find the prevalence and pattern of CHD in a tertiary care hospital in Kashmir (Jammu and Kashmir).Methods: All children admitted at territary care hospital with age 0-15 years were screened for congenital heart disease. The study was conducted for period of one year to ascertain the prevalence and spectrum of CHDs.Results: A total of 232 patients out of 23000, were found having CHDs measuring a prevalence of 10.5/1000. About 170 (73%) were the acyanotics, and 62 (27%) were cyanotic heart patients. Among the acyanotic heart diseases ventricular septal defect was the most frequent lesion seen in 54 (23%), followed by patent ductus arteriosus in 50 (22%) children. Among the cyanotic heart diseases tetralogy of Fallot was the most frequent cyanotic heart disease seen in 15 (6.4%) patients.Conclusions: Authors observed high prevalence of CHD in our population. The pattern and spectrum of CHD were comparable to national and international data.
RESUMO
Breast cancer is the most frequent cancer among women and also the leading cause of cancer related deaths in women. The patterns of failures in carcinoma breast seem to differ by cell type, pathological stage and by the treatment modality instituted. Breast cancers can recur locally, regionally and distantly. Survival rates decrease progressively as the stage of the disease increases. Aims & Objectives: To evaluate the patterns of failure in patients with Breast Carcinoma after definitive treatment modalities. Methods: We conducted an analytical, nonrandomized, cross-sectional study on the Patterns of Failure in 1238 patients with primary breast cancer who reported to our Regional Cancer Centre from 2002 to 2010. Results: A total of 1238 patients with 1189 females and 49 males were evaluated. Most of the patients were above fifty years of age with breast lump being the most common presentation. Infiltrating ductal carcinoma was the most common histology and stage II being the commonest stage of presentation. Most of the patients were hormone receptor positive and Her 2 neu receptor negative. Overall local failure was 3.9%, regional failure 2.7% and distant failure 22.5%. Overall 5 year disease free survival was 78.4%. Conclusion: The most common form of local failure is chest wall recurrence, regional failure is supraclavicular lymphadenopathy and distant failure is bone metastasis. The 5 year disease free survival is lower for all the stages when compared to world scenario. This may be attributed to more aggressive disease behaviour in our patients.