ABSTRACT
Background: Blood pressure (BP) management is imperative in reducing risk of adverse events in continuous flow (CF) left ventricular assist device (LVAD) patients. The gold standard for non-invasive blood pressure (BP) measurement in these patients is Doppler ultrasound, which requires training and dexterity and is not routinely used in the outpatient setting. In the current COVID-19 pandemic era, telehealth assessment has become mandatory to assess and monitor patients. At our institution, we have issued all CF-LVAD patients with a Doppler ultrasound device and an oscillometric BP monitor, and provided training to correctly use these devices. Accuracy of BP measurements in this setting has not been confirmed. Aim: We examined whether Doppler BP obtained by CF-LVAD patients (pts) correlates to Doppler BP obtained by health care workers (HCWs). Methods: CF-LVAD pts were recruited between November 2020 and January 2022. During these routine outpatient follow-up visits, Doppler BP measurements were obtained simultaneously and independently by pts and HCW. BP was taken in a comfortable seating position following 5 minutes rest. Results: A total 223 pairs of simultaneous patient Doppler BP readings and HCW Doppler BP readings were obtained from 38 CF-LVAD patients (87% male, mean age at implant 52 + 14 years, 15 HeartMate3 and 23 HeartWare HVAD, with support duration range 28 - 3492 days). Patient Doppler BP (average 85.9 + 9.8 mmHg) correlated closely with HCW Doppler BP (average 86.1 + 9.6 mmHg), r2=0.90, p<0.0001. There was no significant difference between BP taken by the patient and HCW (p=0.4). The mean difference between the two methods was -0.17 mmHg and the standard deviation was 0.22 mmHg (figure) using Bland-Altman analysis. Conclusions: These results demonstrate that in our patient-population, Doppler-derived blood pressure measurements in CF-LVAD patients were accurate and reliable. This supports the routine use of home Doppler BP measurement and monitoring by CF-LVAD patients, especially in the telehealth era. (Figure Presented).
ABSTRACT
Kaba Suram (phlegmatic fever) is one among the 64 types of Suram (Pyrexia/fever), its synonyms, causes, pathology and characteristics have been mentioned crystal clear in Siddha literature. Its clinical features have been mentioned in few literatures such as Theran karisal, Suravagadam, Yugi chinthamani etc., which are almost similar to each other. The present day pandemic disease COVID-19 which still lacks specific drug towards its management or prophylaxis has become the spectrum of research focus in current scenario. Upon keen understanding of the Siddha literature the signs and symptoms of Kaba Suram fall in line with COVID-19 and a few other flu like illnesses. Therefore, the herbal decoction Kaba Sura Kudineer (KSK) indicated for the management of Kaba Suram has been recommended by the Siddha research community towards an integrated approach in tackling this worldwide emergency. The current scientific community demands evidence based explanation to understand the concept of Siddha system of medicine and necessitates International standards to reassure the efficacy of Siddha medicine. In this aspect, this review is aimed at evaluating all the available informations on Kaba Suram in Siddha literature and pathophysiology of COVID-19 and to interpret the search results in terms of pathophysiology of Kaba Suram based on Mukkutram theory. This effort would therefore enable the Siddha research community to opt for effective Siddha medicines to manage the present pandemic situation.