Showing papers in "Journal of the Practice of Cardiovascular Sciences in 2015"
TL;DR: The Chi-square test as mentioned in this paper was developed by Karl Pearson to evaluate whether there is an association between rows and columns in a contingency table and the proportions of the risk factor of interest.
Abstract: In medical research, there are studies which often collect data on categorical variables that can be summarized as a series of counts. These counts are commonly arranged in a tabular format known as a contingency table. The chi-square test statistic can be used to evaluate whether there is an association between the rows and columns in a contingency table. More specifically, this statistic can be used to determine whether there is any difference between the study groups in the proportions of the risk factor of interest. Chi-square test and the logic of hypothesis testing were developed by Karl Pearson. This article describes in detail what is a chi-square test, on which type of data it is used, the assumptions associated with its application, how to manually calculate it and how to make use of an online calculator for calculating the Chi-square statistics and its associated P-value.
140 citations
TL;DR: A higher in-hospital and follow-up mortality rates in ADHF patients who present at younger ages than reported in Western literature is reported, which provides insights into the current status of acute HF care in India.
Abstract: Objectives: There is a paucity of data on acute decompensated heart failure (ADHF) in Indian patients. We herein report the in-hospital and 6-month outcome of Indian patients admitted with ADHF. Methods: We prospectively enrolled consecutive patients with ADHF due to systolic dysfunction in the acute failure registry and followed them up for at least 6 months. We analyzed the data on death and hospitalization of the first 90 patients on death and hospitalization over 6-months. Results: A total of 90 patients were enrolled with a mean age of 53.5 ± 17. 7 years and the majority were male (63%). The mean left ventricular ejection fraction was 29.2± 11.9%. The in hospital mortality was 30.8%. Postdischarge 6-month major adverse event (re-hospitalization/mortality combined) and mortality rates were 39.5% and 26.3%, respectively. Conclusions: These data from a single referral center provide insights into the current status of acute HF care in India. We report a higher in-hospital and follow-up mortality rates in ADHF patients who present at younger ages than reported in Western literature.
18 citations
TL;DR: The Student's t-test as mentioned in this paper is a method of testing hypotheses about the mean of a small sample drawn from a normally distributed population when the population standard deviation is unknown, and it has been used extensively in statistical analysis.
Abstract: Student's t-test is a method of testing hypotheses about the mean of a small sample drawn from a normally distributed population when the population standard deviation is unknown. In 1908 William Sealy Gosset, an Englishman publishing under the pseudonym Student, developed the t-test. This article discusses the types of T test and shows a simple way of doing a T test.
12 citations
TL;DR: These findings demonstrate that cardiac CM is capable of effective induction of morphological and molecular changes in MSCs toward cardiac features, however, differentiation efficiency is less than that of 5-AZA and the mode of action and the components of CM are still to be known.
Abstract: Background: Mesenchymal stem cells (MSCs) are multipotent and can be easily cultured and expanded Therefore, these are considered to be an attractive therapeutic tool for cardiac repair These have been found to have tremendous potential to transdifferentiate to cardiac lineage both in vitro and in vivo A number of chemicals and growth factors have been explored for the same However, the effect of the paracrine factors released by cardiac tissue has not been studied much Materials and Methods: In the present study, we have examined the differentiation capacity of conditioned media (CM) derived from human cardiac tissue on human bone marrow-derived MSCs (BM-MSCs) BM-MSCs after characterization were induced by culture supernatant collected from human cardiac tissue (21 days) Parallel cultures treated with 5-azacytidine (AZA) (30 days), were taken as controls Results: MSCs treated with CM formed “muscle island” like structure and were found to be positive for cardiac-specific markers - myosin light chain-2v and cardiac troponin I proteins However, uninduced BM-MSCs did not show positivity for any of these markers and maintained fibroblastic morphology Conclusion: These findings demonstrate that cardiac CM is capable of effective induction of morphological and molecular changes in MSCs toward cardiac features However, differentiation efficiency is less than that of 5-AZA and the mode of action and the components of CM are still to be known
10 citations
TL;DR: No new prophylactic options against RF have emerged in the intervening 60 years, and delivery of regularly scheduled BPG injections remains a world wide challenge.
Abstract: The association between group A streptococcal infection and rheumatic fever (RF) was established in the early 20 th century. At the time, RF and subsequent rheumatic heart disease (RHD) were an untreatable scourge of young people in developed and developing countries. Resultingly, research efforts to understand, treat and prevent the disease were widepread. The development of antibiotics in the 1930s offered therapeutic promise, although antibotic treatment of acute RF had little impact. Improved understanding of the post-infectious nature of RF prompted attempts to use antibiotics prophylactically. Regular doses of sulphonamide antibiotics following RF appeared to reduce disease progression to RHD. Development of penicillin and later, benzathine penicillin G, was a further thereputic advance in the 1950s. No new prophylactic options against RF have emerged in the intervening 60 years, and delivery of regularly scheduled BPG injections remains a world wide challenge.
9 citations
TL;DR: The historical evolution of the prosthetic heart valves from the first attempts with the Hufnagel′s valve in the treatment of the aortic insufficiency to the Starr-Edwards′ ball valve and later the tilting disc valves and finally the bileaflet valves are discussed.
Abstract: The historical evolution of the prosthetic heart valves from the first attempts with the Hufnagel's valve in the treatment of the aortic insufficiency to the Starr-Edwards' ball valve and later the tilting disc valves (Bjork-Shiley etc.,) and finally the bileaflet valves (St. Jude) are discussed. The Indian contribution with Chitra valve is also described.
6 citations
TL;DR: The PvPI has recently introduced the facility for consumers to report ADRs, which could potentially fill the huge gap in spontaneous ADR reporting and supplement the indigenous drug safety database with patients′ perspectives regarding ADRs e.g. effect on their quality of life.
Abstract: Drugs used for the treatment of cardiovascular disorders are frequently reported to cause adverse drug reactions (ADRs), second only to antimicrobials. ADRs strain the patients' health and finances further and could prove fatal too. Pharmacovigilance programs aim to detect, monitor and understand ADRs in order to prevent them. Pharmacovigilance provides vital input to drug regulatory agencies to monitor safety of new as well as old drugs. Spontaneous reporting of suspected ADRs by healthcare professionals forms the backbone of pharmacovigilance programs worldwide including the Pharmacovigilance Program of India (PvPI) launched in 2010. The PvPI has significantly contributed to strengthening pharmacovigilance in India but suffers from under-reporting of ADRs like similar programs worldwide. Consumer-initiated reporting of ADRs incorporated in pharmacovigilance programs of several countries has been found to decrease under-reporting rates besides supplementing traditional pharmacovigilance information. The PvPI has recently introduced the facility for consumers to report ADRs by contacting a hotline (1800-180-3024), through e-mail (pvpi.compat@gmail.com) or by filling specifically designed ADR reporting forms, either in English language or vernacular translations, and submitting them to the nearest ADR monitoring centre. This is a welcome step in empowering patients as consumers of drugs with the mechanism to monitor their safety. It could potentially fill the huge gap in spontaneous ADR reporting and supplement the indigenous drug safety database with patients' perspectives regarding ADRs e.g. effect on their quality of life. Whether it encourages rational prescription practices by doctors or enhances transparency regarding safety of investigational drugs in clinical trials needs to be seen.
6 citations
TL;DR: Dilated Cardiomyopathy is often familial and all possible candidate genes should be screened to identify mutations and such type of exercise may help in the identification of mechanistic pathways.
Abstract: Background: Dilated Cardiomyopathy (DCM) is a genetic disorder where a heterogeneous group of cardiac-muscles are involved and is characterized by ventricular dilatation, impaired systolic function, reduced myocardial contractility with left ventricular ejection fraction (LVEF) less than 40%. Our study aims to report the Demographic, Clinical and Genetic profile of Indian Dilated Cardiomyopathy patients. Methodology: All patients were recruited with prior written informed consent and are of Indian origin. Results: In a total of 80 DCM patients, the prevalence was higher among males. In males, mean age of onset was comparatively less than females. In this cohort, 40% had familial inheritance. Sixty two percent of DCM patients belong to NYHA functional class II with ejection fraction (EF) ranging between 21-30% and, around one third of the patients had atrial fibrillation (AF). Genetic screening revealed a novel splice site mutation LMNA (c.639+ G>C) and a rare variant MYH7 (c.2769 C>T) in a patient and insilico analysis of both variants suggested functional changes that were considered pathogenic. We report 3% and 4% occurance of variants, each in LMNA and MYH7, where as reported frequencies of these genes are 6% LMNA and 4% MYH7. Conclusions: DCM is often familial and all possible candidate genes should be screened to identify mutations. Such type of exercise may help in the identification of mechanistic pathways. Next generation sequencing platforms may play an important role in this respect in future.
6 citations
TL;DR: Low HoloTc levels could be a risk factor in the development of CAD, and several proteins involved in lipid metabolism, blood coagulation, cholesterol metabolic process, and lipoprotein metabolic process were found to be altered in individuals having low HoloTC levels.
Abstract: Background: Vitamin B 12 (cobalamin) is a water-soluble vitamin generally synthesized by microorganisms. Mammals cannot synthesize this vitamin but have evolved processes for absorption, transport and cellular uptake of this vitamin. Only about 30% of vitamin B 12 , which is bound to the protein transcobalamin (TC) (Holo-TC [HoloTC]) enters into the cell and hence is referred to as the biologically active form of vitamin B 12 . Vitamin B 12 deficiency leads to several complex disorders, including neurological disorders and anemia. We had earlier shown that vitamin B 12 deficiency is associated with coronary artery disease (CAD) in Indian population. In the current study, using a proteomics approach we identified proteins that are differentially expressed in the plasma of individuals with low HoloTC levels. Materials and Methods: We used isobaric-tagging method of relative and absolute quantitation to identify proteins that are differently expressed in individuals with low HoloTC levels when compared to those with normal HoloTC level. Results: In two replicate isobaric tags for relative and absolute quantitation experiments several proteins involved in lipid metabolism, blood coagulation, cholesterol metabolic process, and lipoprotein metabolic process were found to be altered in individuals having low HoloTC levels. Conclusions: Our study indicates that low HoloTc levels could be a risk factor in the development of CAD.
6 citations
TL;DR: Clinical outcomes of thirty RCM patients recruited from a tertiary care unit of India and found that most of the patients showed the early age of onset with symptoms emerging in the first and second decades of life, shortness of breath and fatigue were found to be common symptoms.
Abstract: Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder with the prevalence of 1 in 500 globally. HCM is clinically characterized by thickening of the wall of the heart, predominantly left ventricle (LV), and interventricular septum (IVS). Our study aims to report the demographical, clinical and genetic profile of Indian HCM patients. Methods: HCM patients were recruited on the basis of WHO criteria. The clinical phenotypes were analyzed using electrocardiography, two-dimensional electrocardiography, and hotspot region of the MYH7 gene was sequenced for all patients as well as for controls. Results: There were 59 patients with a clinical diagnosis of HCM with a preponderance of disease in males with a ratio (men, women) of 5.5:1. Average age of onset of the disease was late 30 s (39.2 ± 14.5) with familial HCM accounting for 18% (n = 9) for total HCM families (n = 50). Nonobstructive kind of HCM was more prevalent as compared to obstructive HCM (66.1% vs. 33.9%). Average posterior wall LV thickness of the HCM patients was 16 ± 4.8 mm and IVS thickness was 21 ± 8.3 mm with familial patients having greater wall thickness as compared to sporadic patients. Sequencing of hotspot region of MYH7 identified three mutations in three different patients. Two mutations were found to be segregating in familial cases. Conclusion: HCM is more prevalent in males with a predominance of hypertrophic nonobstructive cardiomyopathy form. Eighteen percent of cases were familial and showed an early onset of the disease and worse prognosis as compared to sporadic cases. Hotspot sequencing of MYH7 only explains 6% of its genetic basis. More of the candidate genes need to be screened through advanced techniques like next generation sequencing to identify the causal genes which could make us understand the mechanistic pathways.
5 citations
TL;DR: There was no difference in the thiamine level when patients on loop diuretics were compared to controls, however, very lowThiamine levels (<0.1 ng/ml) was significantly more common in patients on loops than in controls, and patients on diuretic had significantly lower thienine level compared to the patients, not on diUREtics.
Abstract: Background: Loop diuretics are an integral part of heart failure management. It has been shown that loop diuretics cause thiamine deficiency (TD) by increasing its urinary loss. The aim of this study was to determine the prevalence of TD in heart failure patients on long-term oral loop diuretics. Methods: Heart failure patients (cases) on oral loop diuretics (furosemide ≥40 mg/day or torsemide ≥20 mg/day), irrespective of the cause of heart failure, were compared to non-heart failure patients (controls) not on loop diuretics in a 1:1 ratio. Whole blood free thiamine level was determined by liquid chromatography-tandem mass spectrometry method. Results: A total of 100 subjects were enrolled in a 1:1 ratio (50 cases and 50 controls). 67% of the total study population had TD, (defined as whole blood free thiamine level <0.7 ng/ml). There was no difference in mean thiamine level between cases and controls. On comparing patients with TD in both groups, patients on diuretics had significantly lower thiamine level compared to the patients, not on diuretics (P < 0.0001). Conclusions: There was no difference in the thiamine level when patients on loop diuretics were compared to controls. However, very low thiamine levels (<0.1 ng/ml) was significantly more common in patients on loop diuretics.
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TL;DR: A national registry on AF does provide some insight into the causes and effects, and it is necessary to have a precise knowledge of the national burden for formulating national evidence-based policy and guidelines.
Abstract: Atrial fibrillation (AF) is becoming a major public health burden worldwide, and its prevalence is set to increase owing to the increase in the elderly population. Despite the availability of good epidemiological data on the prevalence of AF in the Western countries, the corresponding data are limited from our country. In this article, we have tried to assimilate all the data available. A national registry on AF does provide some insight into the causes and effects. It is necessary to have a precise knowledge of the national burden for formulating national evidence-based policy and guidelines.
TL;DR: Optimal management of CHF improves quality of life, reduces hospitalization rates and prolongs survival for people with this condition.
Abstract: Summary of the Consensus Statement: This statement has been prepared keeping Indian heart failure patients in mind. Optimal management of CHF improves quality of life, reduces hospitalization rates and prolongs survival for people with this condition. Echocardiography is the single most useful test in the evaluation of heart failure, and is necessary to confirm the diagnosis. Plasma B-natriuretic peptide (BNP) measurements may be useful in excluding CHF but not mandatory in India. Educate people with CHF about lifestyle changes (e.g., increase physical activity levels, reduce salt intake and manage weight). Educate people with CHF about CHF symptoms and how to manage fluid load. Avoid prescribing drugs that exacerbate CHF. Prescribe angiotensin-converting enzyme inhibitors (ACEI) at effective doses for people with all grades of systolic heart failure, and titrate to the highest recommended dose tolerated. Angiotensin II receptor antagonists (ARA) may be used as alternatives in people who cannot tolerate ACEIs. Mineralocorticoid receptor antagonists (MRAs) should also be used. For people with stabilised systolic heart failure, prescribe beta-blockers that have been shown to improve outcome in heart failure (e.g., bisoprolol, carvedilol, extended release metoprolol or nebivolol). Titrate to the highest recommended dose tolerated. Prescribe diuretics, digoxin and nitrates for people already using ACEIs and beta-blockers to manage symptoms as indicated. For people who have systolic heart failure (New York Heart Association (NYHA) Class II-IV) despite appropriate doses of ACEIs and diuretics, consider prescribing spironolactone. Eplerenone can be considered in certain setting especially post myocardial infarction though it is more expensive. Consider direct sinus node inhibition with ivabradine for people with CHF who have impaired systolic function, have had a recent heart failure hospitalisation and are in sinus rhythm with a heart rate >70 bpm despite beta blockers or where beta blockers are contraindicated Check for, and treat, iron deficiency in people with CHF to improve their symptoms, exercise tolerance and quality of life Consider assessing people with CHF for biventricular pacemakers and implantable defibrillators. Patients with end stage heart failure have an option for heart transplant and ventricular assist devices which is now available in select centers.
TL;DR: The history of pediatric cardiology in India is traced and Dr. Rajendra Tandon, trained for 2 years at Boston Children Hospital under Dr. Alexander Nadas, joined the Department of Cardiology at the All India Institute of Medical Sciences, New Delhi in 1963.
Abstract: In India, the discipline of cardiology started in the late 1950s and at that time pediatric cardiology was practiced as a part of cardiology specialty. This article traces the history of pediatric cardiology in India. Dr. S. Padmawati and Dr. Kamala Vytilingam underwent training in pediatric cardiology at international centers in the early 1950s and early 1960s. Dr. N. Gopinath successfully closed a ventricular septal defect using a pump oxygenator at Christian Medical College, Vellore. Open heart surgery program kicked off in the 1960s with the tireless efforts of many other surgeons. Dr. Rajendra Tandon, trained for 2 years at Boston Children Hospital under Dr. Alexander Nadas, joined the Department of Cardiology at the All India Institute of Medical Sciences, New Delhi in 1963. This and many other stories are described.
TL;DR: It appears that the biology of ROS is far complex than anticipated before, and a comprehensive understanding of the redox biology of diseases is thus needed for developing targeted therapeutics.
Abstract: Oxidative stress caused by various oxygen containing free radicals and reactive species (collectively called Reactive Oxygen Species or ROS) has long been attributed to cardiovascular diseases. In human body, major oxidizing species are super oxide, hydrogen peroxide, hydroxyl radical, peroxy nitrite etc. ROS are produced from distinct cellular sources, enzymatic and non-enzymatic; have specific physicochemical properties and often have specific cellular targets. Although early studies in nineteen sixties and seventies highlighted the deleterious effects of these species, later it was established that they also act as physiological modulators of cellular functions and diseases occur only when ROS production is deregulated. One of the major sources of cellular ROS is Nicotinamide adenine dinucleotide phosphate oxidases (Noxes) that are expressed in almost all cell types. Superoxide and hydrogen peroxide generated from them under various conditions act as signal transducers. Due to their immense importance in cellular physiology, various Nox inhibitors are now being developed as therapeutics. Another free radical of importance in cardiovascular system is nitric oxide (a reactive nitrogen species) generated from nitric oxide synthase(s). It plays a critical role in cardiac function and its dysregulated generation along with superoxide leads to the formation of peroxynitrite a highly deleterious agent. Despite overwhelming evidences of association between increased level of ROS and cardiovascular diseases, antioxidant therapies using vitamins and omega 3 fatty acids have largely been unsuccessful till date. Also, there are major discrepancies between studies with laboratory animals and human trials. It thus appears that the biology of ROS is far complex than anticipated before. A comprehensive understanding of the redox biology of diseases is thus needed for developing targeted therapeutics.
TL;DR: The data indicated that plasma GDF-11 levels were inversely associated with age but did not show any correlation with fasting blood glucose and Hb1Ac levels.
Abstract: Background: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular diseases. Scientific literature reported that growth differentiation factor-11 (GDF-11) has an important role to prevent aging of the heart and decreases with age. However, there is no study to look at plasma GDF-11 levels in diabetes and diabetes associated with cardiovascular complications in India. Therefore, the present study was designed to know the alteration of GDF-11 levels in Indian patients having diabetes and diabetes with cardiovascular complications. Methods: Plasma GDF-11 levels were measured from total 89 age-matched (35-65) subjects by ELISA method. All patients were divided into five groups; control (CT, n = 20), T2DM (n = 15), T2DM with hypertension (T2DM_HTN, n = 14), coronary artery disease (CAD, n = 20), and CAD with T2DM (T2DM_CAD, n = 20). Clinical parameters such as glycated haemoglobin A1c (HbA1c), fasting blood sugar, creatinine, lipid profile, uric acid, and systolic and diastolic blood pressure were measured in all the patients. Results: Plasma GDF-11 levels were measured in all the study groups. We have observed that GDF-11 levels were significantly decreased in T2DM, T2DM_HTN, CAD, and T2DM_CAD subjects compared to CT subjects. Our data indicated that plasma GDF-11 levels were inversely associated with age but did not show any correlation with fasting blood glucose and Hb1Ac levels. Conclusion: Plasma GDF-11 levels were decreased in Indian patients associated with diabetes and diabetes with cardiovascular complications. Further studies are required to understand the role of decreased plasma GDF-11 levels on disease progression and development of cardiovascular complications in diabetes.
TL;DR: IEP (Indigenous Exercise Protocol) training was effective in achieving adequate exercise tolerance in experimental group and is safe to practice at home, but more evidence is needed to consider using IEP when caring for stable heart failure patient.
Abstract: Background: Congestive heart failure (CHF) is characterized by an intolerance to activities of daily living, office environment and shortness of breath in any level of extraneous activity depending on their level of heart failure (HF). This significantly contributes to reduced participation and poor quality of life (QoL) among these patients. Methods: The study was conducted from June 2014 to December 2014 in Cardio-Neuro-Centre, OPD, AIIMS, New Delhi on 40 medically stable CHF outpatients (mean age 46.3±11.4 years) in NYHA class -I & II with 3 month follow-up. IEP (Indigenous Exercise Protocol) training, consisting of one supervised session at baseline visit followed by home-based practice and telephonic encouragement and monitoring of the group was given. Outcome measures were QoL, physiological parameters (6 minute walk test - distance, VO2 max and double product) and frequency of hospitalization. Results: The results showed significant difference between QoL (P < 0.02) as measured by KCCQ, mean walking distance on the 6 minute walk test (P < 0.01) and VO2 max (P < 0.01) at entry and after 12 weeks within the experimental group, but compared to the control group, no significant difference was found between the two groups. Two hospitalizations and one death were reported in the control group, whereas none was reported in the experimental group. Conclusion: IEP was effective in achieving adequate exercise tolerance in experimental group. It showed no deleterious effect and is safe to practice at home, but more evidence is needed to consider using IEP when caring for stable heart failure patient.
TL;DR: Cyanosis in ASD has multiple causes requiring etiology directed management and can present in the setting of elevated pulmonary artery pressure, as in Eisenmenger syndromes having a poor prognosis.
Abstract: Cyanosis in ASD has multiple causes requiring etiology directed management. Cyanosis can present in the setting of elevated pulmonary artery pressure, as in Eisenmenger syndromes having a poor prognosis. Conversely, cyanosis may present in patients having normal pulmonary artery pressure with potentially treatable conditions.
TL;DR: A review attempts to recapitulate the achievements, the potential impacts and the prospective use of this novel technology in early diagnosis of TB, especially focussing pericardial effusion cases.
Abstract: Tuberculous pericardial effusion is a well-known complication of tuberculosis (TB). However, the greatest challenge in front of clinicians is its diagnosis as the conventional methods lack the required sensitivity and specificity of detection. The emergence of drug resistance and co-infections such as human immunodeficiency virus further complicates the situation making it difficult to diagnose such cases. GeneXpert technology is a major breakthrough in the field of TB diagnosis and has opened newer avenues for many new molecular tests to be launched in the future. The World Health Organization endorsed this technology in 2010 for rapid and simultaneous detection of Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. GeneXpert-MTB/RIF assay was highly recommended as an initial diagnostic platform in high burden countries for early and quick detection of TB cases. Until date, very few studies have evaluated the performance of this brilliant assay in pericardial effusion cases, thus, more studies are required to address the unanswered questions left so far. Our review attempts to recapitulate the achievements, the potential impacts and the prospective use of this novel technology in early diagnosis of TB, especially focussing pericardial effusion cases.
TL;DR: The contributions made by Hippocrates to the medical world with an emphasis on the Hippocratic Oath are outlined.
Abstract: For a long-time men had a philosophic view of health and disease, and this lasted till almost 2500 years back. Hippocrates, the great Greek physician, is believed to have seperated the art of healing and philosophy. An astute observer, Hippocrates during his practice employed principles that laid the foundation of modern medicine. The medical fraternity worldwide unanimously bestowed the title of father of medicine to this great man. Apart from being a physician, he was instrumental in bringing about the concept of ethics in the realm of medicine. The famous document Hippocratic Oath while being respected by almost all has generated a great amount of debate among historians. Nonetheless, almost all medical schools across the world have the Oath ceremony where medical graduates agree to the commandments of the Hippocratic Oath, either in its original or modified form. Although a statement of promise this Oath does not have any legal implications as might be seen by a person outside the medical community. This article outlines the contributions made by Hippocrates to the medical world with an emphasis on the Hippocratic Oath.
TL;DR: Systematic reviews and meta-analyses suggest that although overall corticosteroids are associated with a beneficial effect on the variables analyzed, the wide confidence interval and a small number of events make it impossible to draw firm conclusions.
Abstract: Tuberculosis (TB) is responsible for approximately 70% of the cases of large pericardial effusion and the most cases of constrictive pericarditis in developing countries. Early diagnosis and institution of appropriate therapy are critical to prevent mortality. Treatment of TB pericardial effusion consists of 4-drug therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months. Systematic reviews and meta-analyses suggest that although overall corticosteroids are associated with a beneficial effect on the variables analyzed, the wide confidence interval and a small number of events make it impossible to draw firm conclusions. Pericardiectomy is the definitive treatment for constrictive pericarditis, but is unwarranted either in very early constriction where it could be transitory.
TL;DR: In silico analyses in the past few years has emerged as an efficient tool to classify these variants as being lethal or neutral to take into consideration the effect of these variants on the structure and function of the protein.
Abstract: Several individuals, from families at risk for genetic diseases, undergoing genetic testing receive results reporting a variant of unknown significance (VUS) leading to issues in risk assessment, counseling and preventive care. These variants remain frequently unknown because of the lack of information that could establish their direct correlation with predisposition to a disease. In silico analyses in the past few years has emerged as an efficient tool to classify these variants as being lethal or neutral. Most of these techniques take into consideration the effect of these variants on the structure and function of the protein. The review below describes the significance of in silico analyses in classification of these unknown variants.
TL;DR: The incomplete penetrance, genetic heterogeneity, and variable expression in cardiomyopathies paradoxically raise hopes that the development of novel disease modifying therapies may be achievable.
Abstract: Cardiomyopathies are a major cause of heart disease. Not only the patients, but also their families are severely burdened by these illnesses. In the past decade, studies revealed the heterogeneity of these diseases in terms of clinical presentation, as well as their genetics. Studies done in the last few decades revealed a new concept of complex manifestation of cardiomyopathies with different heterogeneity level, penetration, and inheritance. The incomplete penetrance, genetic heterogeneity, and variable expression in cardiomyopathies paradoxically raise hopes that the development of novel disease modifying therapies may be achievable.
TL;DR: A thorough basic set of all relevant investigations including molecular study should be carried out in the evaluation of clinically suspected viral myocarditis patients to identify the active phase of the viral disease process which ultimately helps in the determination of treatment protocol and prognosis.
Abstract: Myocarditis is a challenging diagnosis for both clinician and pathologist due to the extreme diversity of clinical presentation and low sensitivity of detection of myocarditis in the endomyocardial samples. The exact incidence of myocarditis is still not known as endomyocardial biopsy (EMB) is not performed in all suspected cases of myocarditis in majority of the centers. Identification of Dallas criteria in EMB is still considered as a gold standard in the diagnosis of myocarditis. Viral myocarditis is one of the most common causes of myocarditis next to idiopathic or primary myocarditis. Virtually any type of virus can affect the heart. Idiopathic myocarditis should be categorized depending upon the histopathological findings and clinical features as fulminant, chronic active, eosinophilic, granulomatous, or giant cell myocarditis. Hence, a thorough basic set of all relevant investigations including molecular study should be carried out in the evaluation of clinically suspected viral myocarditis patients to identify the active phase of the viral disease process which ultimately helps in the determination of treatment protocol and prognosis.
TL;DR: RP can detect the viral epitopes in peripheral blood samples, heart biopsy tissues samples, or urine/stool sample, and the overall cost-effectiveness makes PCR a technique of choice in the diagnostic armamentarium.
Abstract: Viral myocarditis is now acknowledged as a leading cause of morbidity as well as mortality in cardiovascular diseases. Its treatment is highly dependent on its proper diagnosis as its clinical features overlap with or mimic many other cardiovascular conditions. Histology by endomyocardial biopsy (EMB) confirms its diagnosis but given its own limitations and complications, the noninvasive imaging methods such as echocardiogram and magnetic resonance imaging as well as the molecular techniques like polymerase chain reaction (PCR) have redefined the entire scenario. Of these, PCR can detect the viral epitopes in peripheral blood samples, heart biopsy tissues samples, or urine/stool sample. Moreover, the best use of PCR is exemplified in the EMB samples where scarcity of the sample is not a limiting factor unlike histopathological examination. Detecting the subclinical infections, identifying different strains, and detecting pathogens which are otherwise difficult to grow gives PCR an edge. As it is said “time is money,” thus rapid detection of specific nucleic acid sequences from minute samples, and the overall cost-effectiveness makes PCR a technique of choice in the diagnostic armamentarium.
TL;DR: A management approach in patients with resistant hypertension is summarized, focusing on accurate diagnosis and evidence-based treatments, to optimize BP control.
Abstract: Hypertension is a key determinant of cardiovascular disease morbidity and mortality, directly accounting for approximately 10% of deaths in India. There is a causal association between the magnitude of blood pressure (BP) elevation and adverse cardiovascular event rate, which provides the rationale for implementing BP reduction in routine clinical practice. However, an estimated 30-50% of the hypertensive population remain uncontrolled with a BP >140/90 mmHg, of whom a subgroup fulfill the diagnostic criteria for resistant hypertension. This cohort lies at the extreme end of the cardiovascular risk spectrum, and hence stands to benefit most from specialist input to optimize BP control. This review summarizes a management approach in patients with resistant hypertension, focusing on accurate diagnosis and evidence-based treatments.