ABSTRACT
Polypill is a multi-drug formulation in a single pill intended to simplify the drug regimen and reduce medication-induced adverse effects. The most common multidrug combinations in a polypill are used to treat cardiovascular diseases and are targeted against key modifiable risk factors such as hypertension and hyperlipidemia. These contain blood-pressure lowering agents, statins, and anti-platelet agents usually in a fixed dose. Polypills can be an affordable therapeutic intervention for treating high-risk patients, as these are proven to increase patients' adherence to medication and improve clinical outcomes. Over the previous years, randomized clinical trials of several polypills have yielded contradictory findings, raising skepticism regarding their widespread use in primary disease prevention. Here, we have reviewed the concept of polypills, the evidence-based strengths, the limitations of this polypharmacy intervention strategy, and discussed future directions for their use in the primary and secondary preventive management of cardiovascular diseases and associated risk factors.
ABSTRACT
Introduction: Noninvasive blood pressure monitoring may not accurately reflect cardiac contractility in neonates due to low vascular tone. The perfusion index (PI) is a noninvasive method of assessing the strength of peripheral pulses. It is shown to have a significant correlation with the left ventricular output. This prospective study estimates the correlation between PI and cardiac contractility in neonates. Methods and Results: All hemodynamically stable neonates who were on substantial enteral feeds and not on any respiratory or inotropic support underwent measurement of PI and echocardiography examination. Various indices of left ventricular contractility were estimated, and the correlation coefficient between them and PI was determined. Fifty-six neonates were studied. The median (interquartile range [IQR]) PI was 1.5 (1.25-1.75). The median (IQR) PI in preterm neonates was 1.5 (1.2-1.8) and that in term neonates was 1.8 (1.25-2.7) (P = 0.064). PI had a correlation of 0.205 with fractional shortening (P = 0.129) and 0.13 with left ventricular ejection fraction (P = 0.821). The Spearman's correlation coefficient between PI and velocity of circumference fiber shortening was 0.009 (P = 0.945). The Spearman's correlation coefficient between PI and cardiac output was -0.115 (P = 0.400). Conclusion: The PI does not correlate with left ventricular contractility parameters in neonates.
