Safety and efficacy of ARNI (valsartan/sacubitril) vs ACEI (enalapril) in acute heart failure – A prospective observational study

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

Renal outcome in patients with pre-eclampsia and eclampsia at presentation, three and six months postpartum

To assess the natural history of Renal Disease in patients with Pre-eclampsia or Eclampsia. It was an observational study. This study was conducted simultaneously at two tertiary care hospitals: Fatima Memorial Hospital, l.ahore and Bhatti International leaching Hospital, Kasur from March 2009 to January 2011 women presented with pre-eclampsia or/ and eclampsia were consectively selected for the study fulfilling the inclusion criteria. A total number of 220 patients were eniolled in this study. All parameters required f'or the study were done carefully as blood pressure, proteinurla, renal function tests, urinary creatinine, weight, primary or multiparous, any previous history of pre-eclampsia. These parameters are checked at three and then six months post delivery. Among 220 patients, 140 [63.6%] were primigravida and 80 [36.4%] were multigravida. Blood pressure was from 140/90 to 210/110mmHg average blood pressure was 175100. 195 [8863%] patients had deranged renal function tests and 215 [97%] patients had protelnuria >2+. At Three months post-delivery 151[68.6%] patients achieved normal blood pressure and 190[86.3%] had normal serum creatinine i-e < 1.4. At six months 161 [73.8%] got adequate control of blood pressure, 59 [26.81%] had blood pressure > 140/90. Serum creatinine became in normal range in 195 [88.63%]. Acute renal failure was observed in 6 patents who weie put on renal replacement therapy

Frequency of anti-tuberculous therapy-induced hepatotoxicity in patients and their outcome

Tuberculosis [TB] is a very common droplet infection especially in the northern areas. If untreated, the disease may be fatal within 5 years in more than half of cases. To study the frequency of anti-tuberculous therapy [ATT] induced hepato-toxicity was the subject of the present hospital based descriptive study. The study was conducted in Medical Unit, Ayub Teaching Hospital and patients with diagnosed Tuberculosis in whom ATT was initiated were included in the study. The subsequent development of elevated liver enzyme levels and hepatitis, amongst some members of the study group; was diagnosed, with the help of clinical findings and Liver Function Tests [LFT's] and were dealt with according to severity. Out of the 500 patients studied 277 [55.4%] were male and 223 [44.6%] were female, 203 [40.5%] were in age group 21-35 years, 136 [27.1%] in age group 36-50 years, 141 [28.1%] in age group 51-65 years while 20 [4%] were above 65 years of age. Out of them 40 [8%] developed hepatotoxicity, 21 [4.2%] patients amongst the study group developed overt hepatitis, 20 [4%] of them made an uneventful recovery while 1 [0.2%] died of Fulminant Hepatic Failure [FHF]. ATT-induced hepato-toxicity, was frequently encountered in patients put on ATT

Exercise capacity of Saudi with symptoms suggestive of cardiovascular disease in a military hospital in Western Saudi Arabia

To analyze the results of exercise tolerance test ETT of Saudi women and assess their exercise capacity. A hospital based retrospective cohort analysis was carried out on all Saudi women referred to the Cardiology Department for ETT from February 2005 to June 2007. They underwent symptom limited treadmill test according to the standard Bruce protocol with exercise electrocardiogram monitoring. One hundred and seventy-six women were included in the study. Fifty-one 31.9% patients did not achieve target heart rate. The mean age +/- SD was 48.3 +/- 9.3 years. There was no association of age, diabetes mellitus, hypertension, positive family history of ischemic heart disease IHD and hyperlipidemia to achieve target heart rate p>0.05. Exercise time was influenced by diabetes mellitus p = 0.054 and hyperlipidemia p = 0.044. The mean exercise time +/- SD was 5.15 +/- 2.63 minutes and the mean exercise capacity +/- SD was 6.29 +/- 2.52. metabolic equivalent. Sensitivity was 36.4% 95% CI 29.3-44.6, specificity 92.3% 95% CI 80.5-96.8, positive predictive value 26.7% 95% CI 21.3-31.4, negative predictive value 95.4% 95% CI 90.9-98.3, likelihood ratio for positive result was 4.7 95% CI 3.1-6.2 and likelihood ratio for negative result was 0.69 95% CI 0.48-0.81. Exercise capacity of Saudi women is less when compared to similar studies in women from other regions. Exercise tolerance test can be used to rule out presence of IHD in Saudi women, but value of a positive test is less likely to predict the presence of IHD