The Number Needed To Treat (NNT) is a measure used in epidemiology to convey the effectiveness of an intervention. It is the average number of patients who need to be treated to prevent one bad outcome. It is the reverse of the Absolute Risk Reduction. The lower the NNT, the more effective the intervention. In this article we discuss the concept and limitations of this measure.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: Heart Transplant in India started in 1994. We were initially doing 1-2 per year but the numbers have picked up since 2014 and we have done 25 in the past 3 years. We describe our experience of the last 4 years in this paper. Results: Initially, we experienced a relatively higher rate of rejections, fungal infections and graft failure. As we changed protocols, stopped using induction therapy except in high risk, maintained higher levels of immune suppression and tapered steroids faster in the first year, the complications reduced. All patients who had rejections and all the later transplants were maintained on a regime of tacrolimus, mycophenolate mofetil and steroids along with six months of valgancyclovir, voriconazole and co-trimoxazole. Steroids were tapered by six months to 0.1 mg/kg per day in all patients. Conclusions: In our recent patients, infection was the most common adverse event followed by rejection and PGD. In the latter half of our experience, we found that the complications reduced, suggesting that experience leads to less complications.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

A 27-year-old female presented with generalized body swelling and progressive shortness of breath for the past 4 months. On examination, she had a loud continuous murmur, elevated jugular venous pressure, and gross ascites. The examination findings, electrocardiogram, chest radiography, and echocardiogram are discussed in a step-wise manner to arrive at a diagnosis and plan of management of a patient with ruptured sinus of Valsalva aneurysm is discussed along with review of relevant literature.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

In pediatric cancer, the overall 5-year survival has increased to more than 80%, but these improvements in cancer outcomes have come at the cost of increased morbidity and mortality. These can occur during or early after treatment, and in others may occur many years after cancer treatment is completed. Survivors of childhood cancers are at an increased risk of developing congestive heart failure and premature death due to cardiac causes (coronary artery disease, stroke, and congestive heart failure). There is a strong dose-dependent relationship between anthracycline chemotherapy exposure and risk of congestive heart failure, and the risk is increased in those who have been exposed to chest radiation. Early detection of myocardial injury, prevention of myocardial dysfunction, strategies to promote quick recovery of myocardial function in case of injury, and monitoring for delayed effects of cancer therapy are areas which both oncologists as well as cardiologists looking after cancer patients need to understand. A subspecialty of cardio-oncology has emerged to allow more focus in these areas.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Thromboembolic complication rates of 20%–30% were initially a major limitation to the widespread use of left ventricular assist devices. The success of the HeartMate (Thoratec, Corp., Pleasanton, CA, USA) device has been partly due to the reduced incidence of thromboembolic events, although anticoagulation regime has been recommended for this mechanical circulatory support. We here present a case with the placement of HeartMate II in a patient, noncompliant to medical therapy where device worked for 8 months without any anticoagulant or antiplatelet therapy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The first ever successful cardiac surgery was a repair of a stab wound of the right ventricle by Dr Ludwig Rehn from Frankfurt, Germany on 7^th September 1896. It required Dwight Harken to successfully operate on bomb victims of world war II and to save more than 100 soldiers to open the heart to surgical techniques. He operated on 130 soldiers without a single fatality. This article recalls these two moments of cardiac surgery.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Patients with systolic heart failure (HF) frequently have symptoms despite receiving standard treatment. The addition of the selective heart rate inhibitor ivabradine has been shown to improve their quality of life (QOL) in randomized trials but not under day-to-day practice conditions. Objective: The objective of the study was to assess changes in QOL after the addition of ivabradine to the standard treatment of patients with systolic HF, in daily clinical practice. Patients and Methods: In a multicenter surveillance protocol, patients with a diagnosis of systolic HF who were prospectively prescribed ivabradine 5–7.5 mg twice a day for 60 days were selected for surveillance on their QOL. Primary data on demographic and clinical characteristics, together with a change in QOL assessed by a visual analog scale, during a 60-day follow-up, were extracted for analysis from the case records of patients kept with the investigators. Results: In 594 patients with systolic HF who received ivabradine in addition to standard treatment for 60 days, intention to treat analysts showed that 465 (78.3%, 95% confidence interval (CI), 74.7–81.4) had improvement in QOL. The mean (95% CI) QOL score increased by 37.0% (35.1–39.1). Conclusion: These results confirm the observations of previous randomized trials that in day-to-day clinical practice, patients with systolic HF benefit from an improvement in QOL when ivabradine is added to their standard treatment.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Cardiac injury due to any cause leads to cardiac cell damage and thereby to ventricular dysfunction. Unlike current medical therapy, cardiac regeneration by stem cell therapy is a promising approach which has a potential to reverse left ventricular dysfunction. It is conceived to complement and potentially transform available therapeutic armamentarium. Early experience in clinical studies support the safety and feasibility of cell therapy and as adjuvants to established practice. This review discusses type of stem cells used, its therapeutic indications, and its current status.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]