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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).
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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.
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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.
RESUMO
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.