Real World Evidence of Bempedoic Acid on Efficacy and Safety in Patients with Uncontrolled LDL-c and at High Risk of CVD

Background and Objective: Cardiovascular disease (CVD) is a significant cause of morbidity and mortality worldwide, with high-risk patients requiring effective management to reduce their risk of cardiovascular events. Bempedoic acid is a novel therapeutic agent recently approved as an add-on therapy to statins in patients with uncontrolled LDL-c. Bempedoic acid inhibits cholesterol synthesis in the liver, which ultimately reduces the risk of cardiovascular events. Therefore, the present study aims to assess the efficacy and safety of bempedoic acid in patients with uncontrolled LDL-c (Previously on moderate or high-intensity statins) with a high risk of CVD in real-world settings. Methods: This is a multicenter, retrospective, observational study on the data of high-risk-CVD patients collected from Bempedoic Acid on Efficacy and Safety in patients (BEST) Registry. The clinical data of 140 patients who were already on statin therapy and were receiving Bempedoic acid at a dose of 180 mg, along with measurements of the level of LDL-c, HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, serum creatinine was taken into consideration. The primary outcome includes a change in LDL-c level, and secondary outcomes involve a change in the level of HbA1c, HDL, TG, TC, PPPG, FPG, AST, ALT, and serum creatinine at week 12 and 24. Adverse events were reported at both time points. Results: A total of 140 patients were included in the present study with a mean age of 51.8 ± 9.2 years and had primary confirmed diagnosis of dyslipidemia with uncontrolled LDL-c. The mean levels of LDL-c decreased from the mean baseline value of 142.67 ± 46.49 mg/dL, to 106.78 ±33.92 mg/d; a statistically significant reduction by 23.23% (p < 0.01) at week 12. Similarly, at week 24, the mean LDL-c value reduced to 90.39 ± 38.89 mg/dL. A 33.38 % decrease was observed (p < 0.01). Other parameters such as non-HDL, FPG, PPPG, AST and serum creatinine also showed statistically significant reduction at week 12 and week 24. Conclusion: The present study demonstrates that bempedoic acid is an effective add-on medication in lowering LDL-c levels in high-risk CVD patients with uncontrolled LDL-c.

A study of primary cesarean section-its rate, indications, and complications in a tertiary healthcare in Sikkim

Background: The indication of performing lower uterine section caesarean section has been changing a lot in recent year and they are expected to go on changing on basis of continuing trials. Aims and Objectives: The aims to study are to assess rate, frequency along with complications of primary cesarean section. Along with to study the incidence and indications of primary cesarean section and causes maternal as well as fetal morbidity and mortality in these cases. Materials and Methods: This prospective study included all pregnant women after 28 weeks period of gestation who underwent caesarean section for the 1st time between December 2016 and June 2018 at Central Referral Hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim – India. Over a period of 1.5 years, 750 women at Central Referral Hospital, SMIMS, Sikkim, India, underwent primary cesarean section. Results: The percentage of primary lower uterine section cesarean section was 27.38% and total cesarean section rate was found to be 49.59% which is far more than the expected rate of 15% as proposed by the world health organization. Elective lower uterine section cesarean section was done in 341 cases (45.47%) and emergency lower uterine section caesarean section was done in 409 cases (54.53%). Patient’s desire was the most frequent indication for elective lower uterine section cesarean section (38.40%). Conclusions: There is tremendous rise in rate of primary cesarean section with patient’s request being the most common indication of elective lower uterine section cesarean section.

A cross-sectional study of reticulocyte count and hemoglobin content of umbilical cord blood with relation to maternal factors in newborns of Sikkim

Background: The hematological values of the new born is amenable to certain changes under the influence of fetal, maternal, and environmental factors. Aims and Objectives: The aims of this study was to study the effect of maternal factors on hemoglobin content and reticulocyte count in umbilical cord blood of newborns of Sikkim. Materials and Methods: A total of 150 cord blood samples from newborns delivered at CRH Hospital and STNM Govt. Hospital, Gangtok, Sikkim were analyzed. Two ml of cord blood was taken in an ethylene diamine tetra acetic acid tube under aseptic condition and within 6 h: Hemoglobin estimation and Reticulocyte count was done. Results: The mean reticulocyte count was 2.48 ± 0.87% in normal vaginal delivery (NVD) and in C/S was 3.06 ± 0.97%. The mean hemoglobin content was 13.9 ± 2.6 g/dL in NVD and in C/S was 16.1 ± 3.4 g/dL. P < 0.05 for cord hemoglobin and reticulocytes in relation to mode of delivery was found to be highly significant. The mean reticulocyte count was 2.85 ± 1.0% in normal pregnancy and in complication of pregnancy was 2.9 ± 0.70%. The mean hemoglobin content was 15.36 ± 3.31 g/dL in normal pregnancy and in complication of pregnancy was 16.1 ± 3.4 g/dL. The reticulocyte count was found to be statistically significant in relation to complication of pregnancy. The mean mother’s hemoglobin was 11.16 ± 1.27 when cord hemoglobin content was <14 g/dL and was 11.88 ± 1.24 g/dL when cord hemoglobin content was >14 g/dL. There was statistical significance between the cord hemoglobin content and the hemoglobin content of the mother. Conclusion: Maternal anemia leads to lower circulating hemoglobin in new born. Cord blood screening is a useful means for identification of anemia in neonatal period. High reticulocyte count in neonates denotes active erythropoiesis which might help to defer transfusion unless there were other special reasons for proceeding.

Clinico-Epidemiological Study of Pericardial Effusion in Northern India

Background: Pericardial effusions may be discovered incidentally or as life-threatening scenario of cardiac tamponade. Hence, etiological identification of pericardial effusion proves crucial in-patient management. Aim: To assess the clinical presentation and etiology of pericardial effusion at a tertiary-care centre in India. Methods: This was a retrospective, observational, single-centre one-year hospital-based study. Data from 70 diagnosed cases of pericardial effusion from our tertiary-care centre in India from August 2016 to July 2017 was retrospectively reviewed. A diagnosis of pericardial effusion was confirmed based on findings from clinical history, examination, specific laboratory investigations, and radiological investigations. Pericardial fluid analysis was also performed. Results: The mean age of the patients was 46.87±14.40 years. Almost equal frequencies of men 36 (51.4%) and women 34 (48.6%) were observed. The most commonly observed signs/symptoms of patients diagnosed with pericardial effusion was raised jugular venous pulse in 39 (55.7%) patients, breathlessness in 36 (51.4%) patients, and tachypnea and tachycardia (heart rate >100 beats per minute) in 33 (47.1%) patients each. An etiology of tubercular effusion was common in 32 (44.4%) patients. On analyzing data according to the underlying etiology, the most frequent sign/symptom was raised jugular venous pulse in 20 (62.5%) patients diagnosed with tubercular effusion, tachypnea in 10 (52.6%) patients diagnosed with hypothyroidism and tachycardia in 12 (63.2%) patients with a diagnosis other than pericardial effusion or hypothyroidism. Conclusions: The high prevalence of tuberculosis in India warrants increased control and awareness of this infection.

Do technological advances in linear accelerators improve dosimetric outcomes in stereotaxy? A head‑on comparison of seven linear accelerators using volumetric modulated arc therapy‑based stereotactic planning.

INTRODUCTION: Linear accelerator (Linac) based stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) using volumetric modulated arc therapy (VMAT) has been used for treating small intracranial lesions. Recent development in the Linacs such as inbuilt micro multileaf collimator (MLC) and flattening filter free (FFF) beam are intended to provide a better dose conformity and faster delivery when using VMAT technique. This study was aimed to compare the dosimetric outcomes and monitor units (MUs) of the stereotactic treatment plans for different commercially available MLC models and beam profiles. MATERIALS AND METHODS: Ten patients having 12 planning target volume (PTV)/gross target volume’s (GTVs) who received the SRS/SRT treatment in our clinic using Axesse Linac (considered reference arm gold standard) were considered for this study. The test arms comprised of plans using Elekta Agility with FFF, Elekta Agility with the plane beam, Elekta APEX, Varian Millennium 120, Varian Millennium 120HD, and Elekta Synergy in Monaco treatment planning system. Planning constraints and calculation grid spacing were not altered in the test plans. To objectively evaluate the efficacy of MLC‑beam model, the resultant dosimetric outcomes were subtracted from the reference arm parameters. RESULTS: V95%, V100%, V105%, D1%, maximum dose, and mean dose of PTV/GTV showed a maximum inter MLC ‑ beam model variation of 1.5% and 2% for PTV and GTV, respectively. Average PTV conformity index and heterogeneity index shows a variation in the range 0.56–0.63 and 1.08–1.11, respectively. Mean dose difference (excluding Axesse) for all organs varied between 1.1 cGy and 74.8 cGy (mean dose = 6.1 cGy standard deviation [SD] = 26.9 cGy) and 1.7 cGy–194.5 cGy (mean dose 16.1 cGy SD = 57.2 cGy) for single and multiple fraction, respectively. CONCLUSION: The dosimetry of VMAT‑based SRS/SRT treatment plan had minimal dependence on MLC and beam model variations. All tested MLC and beam model could fulfil the desired PTV coverage and organs at risk dose constraints. The only notable difference was the halving of the MU for FFF beam as compared to the plane beam. This has the potential to reduce the total patient on couch time by 15% (approximately 2 min).

Acquaintance with the actuality: community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal.

INTRODUCTION: In Nepal, various field programs such as community diagnosis programmes (CDP) have been initiated to make the education of doctors, nurses and dentists more community oriented and relevant and suited to the health care scenario. Community diagnosis refers to the identification and quantification of the health problems in a community and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of health care. The article presents the main activities of community diagnosis as a core component of community-based education for the medical students at Kathmandu Medical College, Kathmandu, Nepal. METHODOLOGY: A 4 weeks' Community Diagnosis Programme was conducted by MBBS II students (9th Batch) of the Kathmandu Medical College under the supervision of the Department of Community Medicine in November 2006 in the rural community of Gundu VDC (village development committee). The tools used included pre-tested questionnaires, weighing machines, measuring tapes, stethoscopes and sphygmomanometers. After the data collection and compilation, the students presented their findings in oral presentations, accompanied by a written report, including essential recommendations for improving the health status of these communities. RESULTS: The students benefited from the necessary process of integrating clinical skills and a public health approach, so as to enhance their epidemiological thinking and be of greater use to the communities where they will practice. The community also benefited by achievement of behavioral changes leading to healthier lifestyles and increased awareness of health-related matters and their role in quality of life. CONCLUSIONS: CDP is a way to practically demonstrate that the link between a medical college and society is possible. That is, a medical college can serve the community and thus society, with specific activities to improve health and the skills of students who will serve as future health professionals.

Situation of antenatal care and delivery practices.

OBJECTIVES: The study aims to assess the situation of antenatal care usage and delivery practices in the study area. (i) To study the coverage rate for ANC and hospital delivery in different age group, parity, educational status and economic status. (ii)To study the relation of ANC visit and hospital delivery. MATERIALS AND METHOD: The study design is descriptive cross sectional study. The study was carried out in ward no. 9 of Mahankal VDC, Kathmandu. 50 women of reproductive age group who had delivered live birth five years preceding the survey were selected. A semi-structured questionnaire was administered through informal interview. For the women with more than one child, the information was gathered for the last birth. The data were analyzed through the SPSS software. RESULTS: Antenatal visit was a success story. Seventy eight percent of women were using the services. More notable fact was that the 62% of the respondents made antenatal visits for four or more than four times. Seventy two percent of the respondents y received the tetanus toxoid shots. Sixty six percent of the deliveries were hospital deliveries assisted by the doctors. However, 34% of deliveries occurred at home. The difference in ANC visit in different age groups and parity was not much obvious. The educational effect was clear as nearly double women who attained SLC or above, made four or more ANC visit as compared to illiterates. ANC seen as pathway to the institutional deliveries, once again proved its potential. Around 90% of women who made four or more ANC visits delivered in hospital as compared to 18.18% of women who never made any ANC visit. CONCLUSION: The rate of antenatal care use and hospital deliveries in the study area is found good in percentage. The rapid urbanization is taking place in nearby VDCs of Kathmandu. The hospitals in the Kathmandu are accessible to these VDCs. This could be the reason behind increased antenatal care usage and hospital delivery in the study area.

Health profile of school children in Bhaktapur.

OBJECTIVES: To find out the existing common health problems among school children and to arouse health consciousness among the children. MATERIAL AND METHODS: All the students studying in Mandev Amrit Smriti School, Jhaukhel VDC of Bhaktapur District were included in the sample. The methods used were the interview, clinical history and check-up for provisional diagnosis. A semi-structured questionnaire was used to record information regarding name, age, sex, standard in which s/he was studying, physical examination/personal hygiene, anthropometric measurements, clinical findings, provisional diagnosis etc. The medical instruments used in the survey were: weighing machine, measuring tape, and thermometer. Common medicines like Jeevanjal packets, Albendazole tablets for deworming, Metron, amoxicillin, paracetamol, Tagyl etc were also distributed to the needy students. RESULTS AND CONCLUSION: The physical examination of all 118 students in age group ranging from 3 to 13 years of Mandev Amrit Smriti School situated at Jhaukhel VDc of Bhaktapur district was carried out. Thirteen health related problems were detected in this study. The most important three problems were ear problems (22.03%), worm infestation (16.10%) and dental caries (13.56%). Thus school health education should mainly aim at these problems and the care and cleanliness of ears and teeth by proper and regular brushing should be stressed. Applying Water low classification, 33% males were found normal as per their weight for age. 61.9% males were stunted and 4.8 % males were wasted. Likewise, 54.6% females were found normal as per their weight for age. 43.6% females were stunted and 1.8 % females were wasted.

HIV/AIDS and STI related knowledge, attitude and practice among high school students in Kathmandu valley.

OBJECTIVE: To assess the knowledge, attitude and practice of high school students regarding HIV/ AIDS and STI and to determine if a school education programme would bring about statistically significant positive change in the knowledge, attitude and practice regarding HIV/AIDS and STI. METHODS: The study was conducted among 1012 students of various schools in Kathmandu Valley (Kathmandu, Bhaktapur and Lalitpur). The tool for assessment was confidentially administered closed questionnaire both before and after the education programme of 45 minutes single class, standardized education package. RESULTS: Knowledge on some aspect of the disease was quite low in the study group. 45.8% had prior knowledge of HIV, 65.2% knew that HIV/AIDS could be transmitted by sharing same needle, 46.2% knew that vaccine is not yet available for HIV/AIDS. Knowledge about STI was also quite low, 41.5% knew that pus in the urine is a symptom of STI and 41.7% knew that STI is curable. 4.2% of the study group had previous sexual intercourse, 64.2% had sexual intercourse with friend and 35.17% had sexual intercourse with commercial sex workers. 1.8% would commit suicide if they contracted HIV/AIDS. According to sex wise distribution of the sample, female's knowledge about HIV was low 43.2% as compared to male 48%, male's knowledge about transmission of HIV/AIDS from pregnant mother to child was low; 89.7% as compared to female's knowledge 94.2%. Female's knowledge about commercial sex worker as high risk group was low (87.8%) as compared to male's knowledge 90.6%.

Faculty opinion survey following attendance to teacher training workshop in Kathmandu Medical College.

INTRODUCTION: With the growing awareness of the importance of teaching and learning in Universities, the need to improve professional qualities in teachers has been identified. AIM AND OBJECTIVES: This paper describes the outcome of the impact of teacher training workshops on faculty- teaching performance. METHODOLOGY: A total of 30 faculties who had undergone teacher training in the one-year period were included in the study. Survey questionnaire were distributed and all the forms were returned. RESULTS: All (100%) respondents found the teacher training to be very useful/useful for improvement of teaching skills. A total of 76.66% said that the skills learnt in the workshop were very applicable, 80% perceived changes in students classroom behaviour and found their lecture to be more participatory and interactive. As for their own change in behaviour, 66.66% respondents experienced better interaction with the students in classroom. DISCUSSION: The overall impression of the training was very positive. Future studies should include student feed back and classroom teaching observation for faculty teaching evaluation. We also need to utilise the feed back information obtained in this article, to further improve the strength of the future teacher training workshops. The future workshops should include sessions in problem-based learning and follow up refresher courses.

Backache prevalence among groups with long and normal working day.

OBJECTIVES: to describe the prevalence of backache among groups with long and normal working day. DESIGN: A cross sectional study of prevalence of backache among groups with long and normal working day. MATERIAL AND METHOD: Among the 19 wards of Kirtipur municipality, ward no. 11 was selected as a random cluster. 64 households of different socioeconomic status were selected at random. Total of 64 individuals from these households were selected in the study. CONCLUSION: The backache was found to be 62.5% prevalent. 75.8% of individuals in long working day category were found to be suffering from backache whereas 48.4% in normal working day group were suffering from it.

Nuclear, biological and chemical warfare. Part I: Medical aspects of nuclear warfare.

Casualties in earlier wars were due much more to diseases than to weapons. Mention has been made in history of the use of biological agents in warfare, to deny the enemy food and water and to cause disease. In the first world war chemical agents were used to cause mass casualties. Nuclear weapons were introduced in the second world war. Several countries are now involved in developing nuclear, biological and chemical weapon systems, for the mass annihilation of human beings, animals and plants, and to destroy the economy of their enemies. Recently, natural calamities and accidents in nuclear, chemical and biological laboratories and industries have caused mass instantaneous deaths in civilian population. The effects of future wars will not be restricted to uniformed persons. It is time that physicians become aware of the destructive potential of these weapons. Awareness, immediate protective measures and first aid will save a large number of persons. This series of articles will outline the medical aspects of nuclear, biological and chemical weapon systems in three parts. Part I will deal with the biological effects of a nuclear explosion. The short and long term effects due to blast, heat and associated radiation are highlighted. In Part II, the role of biological agents which cause commoner or new disease patterns is mentioned. Some of the accidents from biological warfare laboratories are a testimony to its potential deleterious effects. Part III deals with medical aspects of chemical warfare agents, which in view of their mass effects can overwhelm the existing medical resources, both civilian and military.(ABSTRACT TRUNCATED AT 250 WORDS)