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   Table of Contents - Current issue
September-December 2022
Volume 8 | Issue 3
Page Nos. 135-195

Online since Tuesday, December 20, 2022

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Role of Indian fruits in the prevention and management of hypertension Highly accessed article p. 135
Pankaj Prabhakar
Hypertension (HTN) is a serious health problem worldwide and worse than other cardiovascular diseases. HTN is a chief risk factor for stroke, myocardial infarction, heart failure, aortic aneurysm, peripheral arterial disease, and renal vascular disease. Herbal medicines are used by about 75% to 80% of the world population, in primary health care because of their enhanced tolerability and minor side effects. The consumption of fruits is advised for good health as a result of their high fiber, antioxidant, mineral, vitamin, and phytochemical contents. Of the many fruiting trees, indigenous to India such as mango (Mangifera indica), black plum (Eugenia jambolana), pomegranate (Punica granatum), and amla (Emblica officinalis) are useful in preventing HTN and in the treatment of HTN in validated preclinical and clinical studies. In this review, efforts are made to collate the fruits' antihypertensive effects and their important phytochemicals. Efforts are also made to address the underlying mechanism/s responsible for the beneficial effects of these fruits in HTN prevention and treatment.
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Effect of labetalol for treating patients with pregnancy-induced hypertension: A systematic review Highly accessed article p. 144
Punyatoya Bej, Sambhunath Das
Pregnancy-induced hypertension (PIH) is one of the main causes of maternal mortality. Many first- and second-line drugs are available to treat the condition. Labetalol lowers blood pressure by blocking both α and β adrenergic receptors. It preserves uteroplacental blood flow efficiently. A systemic review was carried out to find the efficacy and safety of labetalol in the treatment of PIH. Three thousand twenty-six studies were retrieved in 20 years. Finally, 28 studies were selected after applying the review criteria. Twenty-three studies detected that labetalol had superior or similar action compared to other drugs in controlling hypertension in patients with preeclampsia and eclampsia. The systematic review concluded that labetalol is a safe, effective, first-choice of drug with few side effects in treating PIH.
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Echocardiographic assessment of left ventricular ejection fraction recovery after primary percutaneous coronary intervention in patients under 40 years of age p. 152
Iram Jehan Balouch, Kamran Ahmad Khan, Sajid Ali Shaikh, Shazia Rasheed, Muhammad Rahman Khalid, Iftikhar Ahmed, Jawaid Akbar Sial, Nadeem Qamar
Context: The context of this study was acute coronary syndrome. Aims: The purpose of the study was to evaluate left ventricular ejection fraction (LVEF) recovery in postprimary percutaneous coronary intervention (PPCI) patients under the age of 40 years. Settings and Design: Observational study, Hyderabad Satellite Center of National Institute of Cardiovascular Disease (NICVD), Pakistan. Subjects and Methods: This study was conducted on 104 patients at “NICVD, Hyderabad Satellite Center.” ST segment elevation myocardial infarction (STEMI) patients of both genders, between 18 and 40 years of age, and those who underwent coronary angiography were included in this study. LVEF of post-PPCI patients was assessed at admission, 40 and 90 days post-PPCI. Statistical Analysis Used: The McNemar–Bowker test was conducted to assess the variations in the distribution of LVEF at 40 and 90 days as compared to the baseline. Results: A total of 104 patients were included in this study. The mean age of the patients was 34.84 ± 4.82 years. The most common risk factors were hypertension 38.5% (40) and smoking 18.3% (19). At 6 weeks, 18.3% of patient's EF was 40%–50%. At 90 days, 23.1% EF was at 40%–50%. Maximum improvement in EF was seen in patients who timely underwent PPCI. Conclusion: A significant improvement in LVEF was observed in young STEMI patients after 40 and 90 days of PPCI. Timely intervention by PPCI not only preserves LV function at baseline but is also associated with better improvement in the short term in premature STEMI patients.
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Awareness of personal protective equipment among frontline postgraduate medical residents who provide care to patients with coronavirus disease-2019 p. 157
Shital Mahendra Kuttarmare, Sujit Jagannath Kshirsagar, Pradnya Milind Bhalerao
Background: To combat the coronavirus disease-2019 (COVID-19) pandemic, which affected the entire world, health-care workers (HCWs) were required to wear personal protective equipment (PPE). PPE offers protection by preventing microorganisms from contaminating hands, eyes, clothing, hair, and shoes. It is mandatory to know about the proper usage of PPE. Objective: The objective of this study was to evaluate the awareness of PPE and its effects on frontline health-care professionals who provide care to patients with COVID-19. Subjects and Methods: This noninterventional cross-sectional questionnaire-based study was conducted in 108 postgraduate (PG) medical residents who have been treated and provided care for COVID-19 in a tertiary care hospital. The Google questionnaire consisted of 25 questions prevalidated through the literature, senior faculty in the department, and ethics. Results: About 87.03% of the 108 PGs were trained in the donning and doffing protocols, whereas 92.59% were aware of the steps. About 62.96% did not follow the two-person protocol for doffing. About 83.33% were aware of the decontamination protocol of PPE. About 64.81% had difficulty intubating and 62.96% had headaches after using PPE. Conclusions: HCWs in a tertiary care center are aware of PPE use and protocols therein. Even though they were adequately trained about protocols, reluctance, and technical difficulties in following them still exist, which can be solved by adequate and repeated training. The problems faced with the use of PPE have appropriate solutions.
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Prognostic value of resting heart rate and heart rate recovery in acute decompensated heart failure: A prospective cohort study p. 161
Mohammad Azharuddin Malik, Raghav Bansal, Sandeep Seth, Neeraj Parakh, Ambuj Roy, Vinay Kumar Bahl
Background: Acute decompensated heart failure (ADHF) remains a problem of public health concern. Better prognostication is needed to predict outcomes in these patients. Resting heart rate (HR) and HR recovery (HRR) have been proposed as prognostic markers for future events. Materials and Methods: Twenty-five patients admitted for ADHF were enrolled. Baseline demographic data and routine investigations were noted for all. After medical stabilization, before discharge, a 6-min walk test (6-MWT) was performed for all patients. Resting HR at the start, maximum HR achieved, chronotropic reserve, and hearing rate recovery was observed 1 min after completing the exercise. All patients were followed for the appearance of a primary composite outcome consisting of death, heart transplant, or hospitalization for HF. Results: Primary composite outcome occurred in 6 (24%) patients, including 3 (12%) deaths and 3 (12%) HF hospitalizations. The patients who had the primary outcome had a trend toward a shorter distance of walking of 6 min (154.33 ± 51.84 vs. 210.53 ± 78.62, P = 0.16). Resting HR was significantly higher among patients with primary outcome (113.00 ± 17.74 vs. 89.58 ± 16.25, P ≤ 0.01). HRR and chronotropic reserve were significantly lower in patients with primary outcome (7.33 ± 1.75 vs. 17.42 ± 9.47, P < 0.01 and 15.00 ± 11.93 vs. 34.94 ± 19.81, P = 0.02; respectively). A resting HR of 109/min, HRR of 9/min, and chronotropic reserve of 20/min had sensitivity/specificity for predicting the primary outcome of 83.33%/89.47%, 84.21%/83.33%, and 84.21% a/as 83.33%, respectively. Conclusions: Elevated resting HR, decreased HR reserve, and decreased chronotropic reserve are associated with hospital readmissions and decreased event-free survival in patients with ADHF. Resting HR is especially helpful in this regard given the simplicity and ease of its assessment.
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I look into the chest: History and evolution of stethoscope p. 168
Rony Vincent
Early physicians were taught with immediate auscultation, placing the ear directly on the patient's chest. They showed reluctance because it was questionable when the patient is obese, nonhygiene, and modesty, especially in cases of females. In 1816, when the freshly graduated physician René-Théophile-Hyacinthe Laënnec had a consultation with a young obese woman with the symptoms of underlying heart disease, he recalled an acoustic phenomenon which is known very well beforehand for him. He rolled up a sheet of paper and placed one end to her chest and another to his ear to listen. Rest is history. He presented his invention to the world and made revolutionary changes in the art of patient care, which is valuable even nowadays. After his discovery, several scientists contributed their works to make this crucial device achieve more potential. Through many years, Laennac's device became the stethoscope that we have today. Now, the stethoscope has become the symbol of the medical profession.
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An unusual case of isolated symmetric bilateral peripheral artery disease of the radial artery of the index finger in systemic sclerosis: A case report and literature review p. 174
Debasish Das, Anindya Banerjee, Abhinav Kumar, Shashikant Singh, Subhas Pramanik
We report an extremely rare and peculiar case of symmetric peripheral small-vessel disease involving only the radial artery of the index finger sparing major vessels in an 80-year-old female with systemic sclerosis (SSc). Our case is the first literature description of bilateral small-vessel peripheral arterial disease only involving the radial artery of the index finger in an octogenarian with SSc. Symmetric small-vessel peripheral artery disease can also be a late manifestation of collagen vascular disease.
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Left main coronary artery arising from the right coronary sinus presenting as acute coronary syndrome: A rare anomaly managed conservatively p. 178
Saket Toshniwal, Twinkle Pawar, Ruchita Kabra, Tarun Rao, Sunil Kumar, Sourya Acharya
Coronary artery anomalies are extremely rare with a prevalence of 2.33% and they are extremely difficult to diagnose with the help of conventional tests. Once diagnosed, the associated life-threatening risks and complications that arise during surgical management are the dangers related to such anomalies. We present a case of a 45–year-old female, with chief complaints of chest pain radiating to back and left shoulder associated with palpitations for 7 days, a known case of systemic hypertension and diabetes mellitus type 2 for 7 years on regular medications. A series of investigations were conducted that included an electrocardiogram showing ischemic changes, a two-dimensional echocardiography that revealed globally dysfunctional left ventricle and an ejection fraction of 45%, and finally, a diagnostic coronary angiography leading to the diagnosis of the an abnormal origin of the left main coronary artery through the right coronary sinus associated with 80% stenotic lesion in the “left anterior descending artery” and 90% stenotic lesion in the “left circumflex artery”. The report concludes that anomalies arising from coronary arteries are extremely infrequent and difficult to diagnose. In addition, they can present with life-threatening complications during surgical management.
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Bioprosthetic tricuspid valve stenosis in a case of rheumatic mitral valve stenosis and tricuspid valve replacement p. 182
Ganeshrao Patilba Sapkal, Satyavan Sharma
Very little is known about the occurrence of bioprosthetic tricuspid valve stenosis in the Indian population that usually occurs within 8–10 years following tricuspid valve replacement (TVR) with a bioprosthetic valve. Here, we present a case of a 43-year-old woman suffering from chronic rheumatic heart disease who underwent prior two open mitral valvotomies and a TVR, now presented with severe mitral regurgitation and severe bioprosthetic tricuspid valve stenosis.
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Truncus bicarotics with arteria lusoria - A rare incidental finding with clinical implications p. 185
Digvijay D Nalawade, Ajitkumar K Jadhav, Pratik Satyajit Wadhokar, Rahul Kadu
Arteria lusoria, an aberrant right subclavian artery originating distal to the ostium of carotid arteries, is the most common congenital aortic arch anomaly. It is commonly associated with other congenital anomalies of the heart and great vessels resulting from embryologic malformation of the aortic arch, including truncus bicaroticus, which is a common trunk of bilateral common carotid arteries. The association between arteria lusoria and truncus bicaroticus is about 29%. We reported a rare case of truncus bicaroticus with arteria lusoria in a 40-year-old male patient detected incidentally during coronary angiography through the right radial approach.
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Pseudoaneurysm formation between ascending aorta and main pulmonary artery following ventricular septal defect patch dehiscence p. 188
Guriqbal Singh, Mrugesh Prajapati, Jigisha Pujara, Trushar Gajjar, Bhavik Chimpaneri, Pavan Patel
Complications of ventricular septal defect (VSD) repair include arrhythmias, tricuspid valve insufficiency, and residual shunt. We are presenting a unique and extremely rare complication of rupture of VSD patch, leading to the formation of pseudoaneurysm between the ascending aorta and main pulmonary artery following VSD patch closure.
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Ehlers–Danlos syndrome Type VI with mitral valve prolapse and regurgitation p. 191
Sourya Acharya, Sandeep Kamat, Samarth Shukla, Anamika Giri, Sunil Kumar
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Emotional intelligence p. 193
Louie Giray
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