Heart rate lowering agents in acute coronary syndrome

Background: Heart rate is a key indicator of cardiovascular mortality, with ACS having the highest mortality risk when heart rate is elevated. With a target heart rate of <70 bpm, it is crucial to evaluate the effects of medications that lowers heart rate. Methods: In this prospective observational study, 45 patients with ACS were studied, and it was determined whether or not the patients' heart rates at discharge from the hospital were within goal range. Additionally, we looked at demographics, drug-related issues, vitals and then statistical tests were performed. Results: The demographic of 45 patients showed mean adult age was 47 years and most observed ACS was STEMI (53.3%). Patients prescribed with HRLA showed lower mean HR, SBP and DBP at discharge. Evaluated Optimal HR ?70 bpm with HRLA therapy at discharge of the inpatients was achieved in 26.6% (63.5±5.5 bpm). Conclusions: The current study showed HRLA therapy effectively reduced the heart rate at hospital discharge, but despite being on HRLA only 1/4th of patients achieved the optimal heart rate.

A prospective study on evaluation of antibiotics usage in patients with sepsis at a tertiary care hospital

Background: Most developing countries are adopting antibiotic usage in sepsis. This study was conducted to evaluate the antibiotic usage in patients and to study medical adherence in high-risk patients. The study in particular aims to evaluate antibiotic usage in sepsis patients along with their related ADR’s. The study also aims to optimize the usage of antibiotics in high-risk patients at a tertiary care hospital. Methods: Study was prospective and observational review of patients record in the hospital. Clinical notes, medication chart and electronic data management system at the hospital were used to analyse usage of antibiotics. Culture and sensitivity reports were obtained from relevant departments. Observations were then compiled and documented. Results: Out of 40 cases collected 22 (55%) patients were male and 18 (45%) were female. Majority of the study population belongs to 71 years and above with 15 (37.5%) followed by age group of 41-60 years with 14 (35%). Most frequently prescribed antibiotics were found to be meropenem 16 (21.33%) and piperacillin tazobactam 14 (18.67%). The most resistant antibiotic was found to be cotrimazole in 35 (87.5%). ADRs were found in 35% of all cases. Conclusions: Prescribing patterns for antibiotics need to be optimized. Adherence to and update of the policy is also recommended. It was found that the adherence to hospital antibiotic policy is low.

A study on drug utilization pattern of anticoagulants in post-cardiac surgeries at a tertiary care hospital

Background: The study is being carried out mainly to understand the prevention of coagulation of blood after a patient undergoing various types of cardiac surgeries, using different anticoagulation therapies suitable to particular types of cardiac surgery. This study was conducted to know the types of anticoagulants prescribed to patients who have undergone different types of cardiac surgeries along with the prescribed anticoagulants. Methods: The study method used was a retrospective and prospective observational study carried out on 50 patients who underwent cardiac surgeries in the department of cardiology and medicine. Results: A total of 50 patients were enrolled for this study who satisfied the inclusion criteria, out of which 64% of patients were males, and 36% were females. The highest number of patients were found to be in between the age group of 61-70 yrs (34%), whereas age group between 51-60 yrs (28%), age group 71 and above (18%), 41-50 (14%), 21-30 yrs (4%) and 18-20 yrs (2%) respectively. Most of the patients had undergone Coronary Artery bypass grafting. It was seen that the highest Anticoagulant being prescribed was Heparin in most of the post-cardiac surgeries. Whereas drugs like dalteparin, acenocoumarol, and warfarin were prescribed the majority in valvular heart surgeries. Conclusions: Various cardiac surgeries were taken into consideration for the study. The most common anticoagulants prescribed were heparin, dalteparin, acenocoumarol, and warfarin in coronary artery bypass surgery and valvular heart surgeries respectively.

Comparative observational study between Atorvastatin and Rosuvastatin based on HbA1c levels of patients diagnosed with acute coronary syndrome and heart failure

Background: Our study aims to compare HbA1c levels in hospitalized acute coronary syndrome and heart failure patients treated with atorvastatin versus rosuvastatin Methods: This is a retrospective, prospective observational study in which the study population includes ACS and HF Hospitalized patients, the study subjects are divided based on patients prescribed with Atorvastatin and Rosuvastatin based on the medication chart, and those patients' previous history of statin use is collected from history chart, patient case notes, doctors notes, laboratory data is collected and documented in data collection form, lab data includes HbA1c, finally compared Atorvastatin and Rosuvastatin using excel and JASP descriptive analysis. Results: Overall, we collected data for 132 cases, of which 55% are males and 45% females, 59.10% are above 61 years of age, 39.39% are diagnosed with ACS and 23.48% are diagnosed with HF, among 67 patients who are using Atorvastatin, there was a significant mean decrease in HbA1c% from 8.359% to 7.901%, and among 65 Rosuvastatin users there was an increase in mean HbA1c% from 8.386% to 8.389%. Additionally for non-diabetic individuals, there was an increase in Hba1c% from 6.339% to 6.387%. Conclusions: We concluded that Atorvastatin is a more effective statin than Rosuvastatin which will reduce the risk of new-onset Diabetes Mellitus in non- diabetic individuals and reduce the risk of increasing complications of diabetes mellitus in patients who are Diabetic.

Evaluation of ?-blockers dosage regimen rationality in heart failure patients

Background: ?-Blockers are often associated with further cardiac function deterioration, ledding to them being often underused/underdosed by certain physicians in heart failure treatment, although they were seen to be beneficial in decreasing the rates of mortality and morbidity, duration of hospitalization in HFrEF patients, but data on their benefits in HFmEF and HFpEF patients is limited. Objective was to evaluate rationality of ?-blockers’ dosage regimen and its effectiveness in HF patients. Methods: 43 HF patients have been enrolled. Data were collected from the medication chart (dose, route, frequency); dosage regimen was evaluated and compared to that of ESC guidelines for HF treatment. Heart rates pre/post drug treatments, ejection fraction (at admission & post-discharge) were recorded; effectiveness was evaluated through heart rate control, reduction in: duration of hospitalization, rehospitalization and mortality rate. Post-discharge updates of the patients were obtained through out-patient consultation reports. Results: In All 43 patients dosage regimen of selected ?-Blockers was found to be rational and following the ESC guideline for HF treatment. 65% of patients spent not more than 5 days in the hospital, 16% Re-hospitalized for cardiovascular diseases, and death rate was 4%. Conclusions: The dosage regimen of selected ?-Blockers was found to be as per that of ESC-guidelines HF treatment. ?-Blockers have also been found to have reduced: hospitalization stay, frequency of rehospitalization, and death rate among patients under study.

A prospective study on antibiotic resistance pattern in patients with urinary tract infection

Background: Antibiotics are a blessing to the mankind in the realm of medical treatment. Quite contrary to that fact, they may cause risks in medical treatments of patients if these antibiotics are not taken under medical guidelines. In the current scenario it is a huge challenge for selecting appropriate antibacterial agents for the treatment of UTI. This study aims to evaluate the prescription & resistance pattern of antibiotics in patients with urinary tract infection. Methods: A prospective observational study was carried out for a period of 1 year. Data on 100 research participants' reports and the results of their tests for antibiotic resistance were taken from the microbiology department's records, evaluated, and represented as percentages. Observations were made and meticulously recorded. Results: Out of 100 study participants, Escherichia coli was the most common pathogen with a total of (35%) followed by Klebsiella (17%), Enterococcus with (16%). E. coli were highly resistant to Ampicillin (88.6%) and Cefazolin (88.6%), Ceftraixone (85.3%). Klebsiella were highly resistant to Ampicillin (100%) Cefazolin (93.3%), Cefuroxime (85.7%). Enterococcus were highly resistant to Tetracycline (92.9%) Ciprofloxacin (85.7%), Levofloxacin (81.8%). Where, E. coli were highly sensitive to Amikacin, Imipenem, Ertapenam. Klebsiella were highly sensitive to Meropenem, Cefoperazone/Sulbactam, Amikacin. Enterococcus was highly sensitive to Linezolid, Teicoplanin, Vancomycin. Conclusions: Most of the identified bacteria were resistant to several of the popular antibiotics used in clinical settings. Consequently, it is vital to prescribe antibiotics rationally both before and after culture reports.