Association Of Heart Rate At Hospital Discharge And Rehospitalization Of Patients With Heart Failure And Reduced Ejection Fraction.

BACKGROUND: One of the major causes of cardiovascular morbidity and mortality is heart failure. The study aims to assess the effect of heart rate on the incidence of rehospitalization in patients with heart failure and reduced ejection fraction. METHODS: It is a cross-sectional, analytical research conducted over six months, from June to December 2022, at the cardiology department of a tertiary care hospital. Patients who satisfied the modified Framingham heart failure criteria at admission and were discharged with an initial diagnosis of heart failure and those readmitted within 6 months or less of their discharge were included in the study. Pregnant women, patients diagnosed with cognitive impairment, and patients who had contraindications for taking any of the beta-blockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker /angiotensin receptor -neprilysin inhibitor, Sodium-Glucose co-transport inhibitor, and mineralocorticoid inhibitors were excluded from the study. RESULTS: A total of 77 patients were included in the study. At discharge, approximately 71 patients had a heart rate of less than 70 beats/min and had no readmissions whereas, 6 patients had a heart rate of greater than 70 beats/min with 5 patients requiring readmission in the following 6 months. This relationship was statistically significant with a p-value of 0.000. CONCLUSIONS: According to the study, heart rate is a significant factor in the rehospitalization of individuals with heart failure and a low ejection fraction. At discharge, if the heart rate is not optimized then the rate of readmissions is increased.

Qualitative Versus Quantitative PCR in Establishing Response to Chronic Hepatitis C Treatment with Sofosbuvir.

OBJECTIVE: To determine the change in rapid virological response for chronic hepatitis C by qualitative PCR testing after treatment with sofosbuvir. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Memon Medical Institute Hospital, Karachi, from January to September 2016. METHODOLOGY: The study population consisted of patients above 18 years, till 80 years of age, of both genders, having chronic infection with HCV. Patients included were treatment-naive, non-responders or relapsers; and among these categories, both cirrhotic and non-cirrhotic patients were included. Initially, genotyping and quantitative PCR test was done, one at the start of treatment then at 4 weeks that is till rapid virological response (RVR) was elicited. Qualitative testing was compared by Chi-square with quantitative assays simultaneously to check sensitivity by qualitative testing. RESULTS: Out of 106 patients, the mean age of the patients was 46.40 ±14 years. There were 39 (36.8%) males and 67 (63.2%) females. One hundred (94.3%) were infected with genotype 3. One hundred and five (99.05%) patients responded to sofosbuvir with successful achievement of RVR after 4 weeks. One patient did not achieve RVR (0.94%). The sensitivity of qualitative test was 99%. CONCLUSION: Qualitative analysis is a cost-effective and sensitive method in patients treated with sofosbuvir for confirming RVR, especially in developing countries where patients are self-paying with significant financial constraints.

Rapid virological&End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C.

OBJECTIVE: To determineRapid & End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C at tertiary care hospital. METHODS: It was an observational study conducted at Memon Medical Institute from January 2016 to July 2017. The inclusion criteria for patients was 18 years of age or older, having chronic infection with HCV. Total=201 received sofosbuvir with or without interferon in our OPDs. Patients were categorized into Treatment naïve, treatment experienced and decompensated chronic liver disease. Pregnant patients and those not willing to participate were excluded. Initially genotyping and Quantitative HCV RNA test was done. RESULTS: A total of 201 subjects were included in the study with mean age of the patients was 46.22± 14.41 years. Of 201 patients, n= 131 (65.2%) chronic hepatitis C, compensated cirrhosis n= 47(23.4%), and with decompensated cirrhosis n=23(11.4%). Most commonly genotype 3 n= 180 (89.6%) was present followed by genotype 1 n=9(4.5%), genotype 2 n=1(0.5%), genotype 4 n=1(0.5%). Of patients with genotype 3, 123 received dual therapy and 57 were given triple therapy. After one month of therapy HCV RNA by PCR, 200(99.5%) achieved RVR, 199(99%) achieved ETR and SVR achieved in 178(88.5%) while remaining 1 patient did not achieved RVR, 2 ETR and 12 patients did not achieved SVR and remaining 11 SVR lost follow up. CONCLUSION: Sofosbuvir has shown to be very effective andsuccessfulwith achievement of virological response with little or no resistance in all genotypes mainly genotype 3 treated in our study population. The promising results of our study will aid in better outcomes and therefore help in eradication of the virus.