bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediabetes and its correlates in a suburban community in South-South Nigeria
Authors: Ejenobo Osaro E , Chike-Ezue Eunice , Eregie Aihanuwa , Edo Andrew 
Published: May 2024

Abstract

Background:
Prediabetes is a high-risk state for diabetes mellitus (DM) and is associated with the chronic complications of DM. There is paucity of data on prediabetes and its associated risk factors in Nigeria, particularly in the suburban setting. The aim of this study was to determine the prevalence of prediabetes and its associated risk factors in a suburban community in south-south Nigeria.

Materials and Methods:
This was a cross-sectional analytical study carried out among 382 adult residents in Mosogar, Delta State. An interviewer-administered questionnaire was used to obtain the socio-demographic and clinical information of the subjects. Anthropometric measurements and blood pressure were done according to standard protocols. Blood sample was collected for oral glucose tolerance test, fasting serum lipid profile, and glycated hemoglobin (HbA1c).

Results:
A total of 350 subjects (36.3% men and 63.7% women) completed the study. The mean (standard deviation) age of the participants was 46 (14.1) years. The prevalence of impaired fasting glucose, impaired glucose tolerance, and impaired HbA1c was 16.6%, 16.3%, and 19.2%, respectively. The overall prevalence of prediabetes and undiagnosed DM was 22.0% and 5.1%, respectively. On multivariate logistic regression, the significant predictors of prediabetes were increasing age, a family history of DM (adjusted odd’s ratio [AOR] 16.14, 95% confidence interval [CI] = 3.25–88.36), overweight (AOR 4.08, 95% CI = 1.72–9.63), obesity (AOR 5.63, 95% CI = 1.59–19.90), inadequate physical activity (AOR 5.28, 95% CI = 2.08–13.41) and elevated triglycerides (AOR 9.69, 95% CI = 1.77–53.18). Moderate alcohol intake was associated with a reduced risk for prediabetes (AOR 0.33, 95% CI = 0.12–0.92).

Conclusion:
There was a high prevalence of prediabetes in Mosogar community, Delta State. There is need for education of community members on dietary and lifestyle modifications aimed at reducing the risk of prediabetes and ultimately diabetes.
A study on normal reference values of echocardiographic chamber dimensions in newborn infants from Eastern India – A pilot study
Authors: HALDER SWAPAN KUMAR , ROY SAMIR KUMAR , MUKHERJEE ANINDYA , KHANRA DIBBENDHU , DAS MALYABAN , SAMANTA BIAUS , SAHA SOUMYOJIT , MANDAL MANORANJAN 
Published: May 2024

Introduction:
Echocardiography has been an integral part of neonatal care since the 1990s and the application of this technology is increasing ever since. It is already known that differences in weight, age, and race significantly affect the normal heart dimensions. Therefore, establishing the normative values for cardiac dimensions among Indian healthy newborn infants is of paramount importance. In this study, we report the normal reference values of echocardiographic chamber dimensions of newborn infants from Eastern India.

Methodology:
One hundred healthy newborn infants were included in this cross-sectional, observational, single hospital-based pilot study. A single experienced cardiologist performed the transthoracic echocardiographic studies on the participants in supine position in their respective bassinets. No sedation was used. The parameters were distributed according to body weight and in percentiles.

Results:
Participants were categorized according to their body weight into three groups: 2–2.4 kg, 2.5–2.9 kg, and 3–3.5 kg. Each group comprises 7, 50, and 43 newborns, respectively. The left ventricular end-diastolic dimension and left ventricular end-systolic dimension showed incremental trends across body weight.

Conclusion:
This study shows the difference of cardiac dimensions in Indian newborn infants from Western data. This is the first study presenting the normative reference ranges and percentiles of echocardiographic parameters in Indian newborn infants which needs confirmation with larger multicenter studies.
Postoperative outcomes in patients with post infarction ventricular septal defect – Institutional experience
Authors: Kakkar Deepti , Desai Devvrat 
Published: May 2024

Context:
Postinfarction ventricular septal defect (VSD) is a rare but serious complication of myocardial infarction with a reported incidence of 1% to 3% in the pre thrombolytic era and <0.5% post thrombolytic therapy. Risk of death is greatest immediately after myocardial defect and then gradually declines. Early surgical treatment is recommended; however, surgical repair is associated with a high rate of mortality.

Aim:
To investigate the immediate survival outcome and prognostic factors associated with surgical repair of postinfarction ventricular septal rupture at our institute over a 3-year period.

Materials and Methods:
From April 2012 to April 2015, 32 patients underwent surgical repair of post-infarction ventricular septal rupture at our institute. Patients were identified from the electronic medical records database and preoperative, intraoperative, and postoperative variables were retrieved. Multiple perioperative variables such as anthropometric data, demography, and clinical history and preoperative details such as echocardiographic indices, coronary angiography, and intraoperative variables were analyzed. The outcomes were compared between the survivors and nonsurvivors.

Results:
Overall, younger patients tolerated the disease and the surgery better than the older population (59.96 ± 10.67 vs. 69.11 ± 8.11; P = 0.02). Female sex, cardiogenic shock (n = 20, 86.95% vs. n = 2, 22.22%; P = 0.001), and emergency surgery were independently associated with higher risk of postoperative mortality. History of systemic hypertension was found to be significantly associated with poor postoperative outcomes (survivors n = 9, 39.1% vs. nonsurvivors n = 8, 88.9%; P = 0.017). In our series, the overall mortality was 28.1% (n = 9). Higher NYHA class at presentation, intra-aortic balloon pump requirement and low ejection fraction are all independently associated with poor outcomes. Longer interval between the myocardial infarct and surgical repair is associated with a lower risk of operative mortality. Preoperative renal dysfunction (61.77 ± 19.04 vs. 41.36 ± 21.15; P = 0.025) and postoperative renal dysfunction (65.26 ± 28.81 vs. 27.27 ± 9.04; P = 0.001) is one of the most important predictors of postoperative outcome. The duration of aortic cross-clamp and cardiopulmonary bypass was not associated with early mortality in this study (89.17 ± 42.70 vs. 97.11 ± 76.38; P = 0.775).

Conclusion:
Postinfarction VSD still remains one of the most challenging conditions to treat surgically with considerable early mortality. Although percutaneous device closure and left ventricular assist devices may be used as a method to stabilize the patient preoperatively and improve the chances of survival after surgery, it is currently not advocated as a definitive treatment option. All efforts should be made to predict and prevent postoperative renal dysfunction as it is the single-most important factor affecting both short- and long-term survival outcomes.
Clinical profile, risk stratification of patients with acute pulmonary embolism
Authors: PATEL KEYUR , BHATIA SANJEEV , BRAHMBHATT JIT , SHARMA VISHAL , MANSURI ZEESHAN , SHARMA KAMAL , JAIN SHARAD , PATEL KRUTIKA , PARMAR PINKESH , VASAVA DIGNESH 
Published: May 2024

Context:
To study the demographics and clinical profile of patients with acute pulmonary embolism (PE) and impact of management as per risk stratification on outcome of patients with acute PE.

Materials and Methods:
Prospective observational study of demographics, clinical profile, risk stratification, management, and outcome of patients presenting with acute PE from August 2016 to July 2017.

Results:
One hundred and fifty patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years, with 70% being males, were included in the study. There were 6 (4%) patients in high-risk group, 69 (46%) patients in intermediate-high subgroup, 39 (26%) patients in intermediate-low subgroup and 36 (24%) patients in low-risk group as per the ESC 2019 guidelines using sPESI score, shock/hypotension, right ventricle (RV) dysfunction and cardiac marker elevation. 72 patients (52%) had antecedent deep vein thrombosis (DVT) of which 60 patients has proximal, whereas 12 patients had distal DVT. One hundred and forty-seven patients (98%) had moderate-to-severe TR, 117 patients (78%) had evidence of right atrium/RV dysfunction and 27 patients (18%) had evidence of thrombus in the heart. Computed tomography pulmonary angiogram showed middle pulmonary artery thrombus/dilatation in 63 patients (42%), saddle thrombus in 18 patients (12%), partial thrombus in the left pulmonary artery (LPA) and right pulmonary artery (RPA) in 84 (56%) and 75 (50%) patients, respectively. Majority (86%) of patients with tenecteplase; 9 (10.3%) patients with streptokinase and 3 (3.4%) was thrmobolysed with alteplase.

Conclusion:
PE can present with unexplained dyspnea and atypical chest pain, among other signs and symptoms. Early diagnosis, risk stratification, and guideline-directed prompt management can lead to favorable outcome.
Safety and efficacy profile of an indigenous developed CHARAK DDDR 747R dual-chamber rate-responsive pacemaker
Authors: Sharma Yash Paul , Batta Akash , Mehrotra Saurabh , Panda Prashant , Sethi Surendra 
Published: May 2024

Aim:
The purpose of this study was to assess the safety and performance of the domestically manufactured Charak DDDR 747R (Pacetronix Ltd, Indore, India) pacemaker device.

Materials and Methods:
This was a prospective, controlled, single-center study conducted between March 2016 and August 2017. Eligible patients were implanted with a Charak DDDR 747R pacemaker with parameters set as specified on the packaging material unless otherwise advised by the physician. Patients were evaluated before discharge and at the 18-month follow-up. Data such as patient age, gender, and medical history were collected to determine patient eligibility for study participation, monitoring of study progress, and data analysis.

Results:
A total of 35 patients were analyzed. Males comprised 45.7% and females comprised 54.3% of patients. The average pacing threshold was threshold (atrium) was 1.05 V and the average pacing threshold (ventricle) was 1.07 V. The average impedance (atrium) was 641.09 Ω and the average impedance (ventricle) was 719.31 Ω. No serious adverse events were documented during the follow-up. One death occurred; however, this was not device-related.

Conclusions:
As per study findings, the Charak DDDR 747R, an indigenous pacemaker, is safe and effective in the Indian population. Durable lead parameters were obtained during the study which remained stable over time referring the same. Future larger studies are needed to confirm the preliminary data obtained from our study.
Use of ivabradine in postoperative junctional ectopic tachycardia
Authors: SHARMA DHRUVA , SUBRAMANIAM GANAPATHY , SHARMA NEHA , SHARMA PREKSHA 
Published: May 2024

Purpose:
When tachyarrhythmias originates from atrioventricular (AV) node, AV junction or bundle of His complex, they are termed “junctional ectopic tachycardia” (JET). Cardiac surgeries especially involving crux of the heart are mainly responsible for JET. Amiodarone and other pharmaco-therapeutic agents are tried as antiarrhythmics for the treatment of postoperative JET. Aim of this review was to discuss about role of ivabradine in the treatment of postoperative JET.

Materials and Methods:
A search was carried out for this review article on the basis of literature available including scientific databases of PubMed, Embase, Scopus, Google Scholar, using keywords “Ivabradine,” “Postoperative junctional ectopic tachycardia,” “Arrhythmias,” “Funny currents,” from October 2011 to October 2020.

Results:
After initial screening of 377 articles, 9 studies were included and discussed in detail in the present review article.

Conclusion:
Treatment of choice of postoperative JET is still not well established. Although there are very few case reports and case series that have been reported on the use of ivabradine in JET, yet it seems to offer a promising use.
Correlation between Troponin I, N-terminal pro–B-type natriuretic peptide, and left ventricular ejection fraction in acute coronary syndrome patients with mortality
Authors: PANSURIYA DARSHIT , KHADKE VRUSHALI , BAHULIKAR ARUN , PHALGUNE DEEPAK 
Published: May 2024

Background:
Troponin I (Trop 1) and N-terminal pro–B-type natriuretic peptide (NT-ProBNP) can be a discerning marker for the patients presenting with symptoms of acute cardiac ischemia and risk of death. The present study was to find a correlation between NT-ProBNP, troponin 1, and left ventricular ejection fraction (LVEF) in acute coronary syndrome (ACS) patients with mortality.

Methods:
Ninety ACS patients >18 years of age were included for this prospective observational study. Each patient was subjected to detailed clinical history, clinical examination, Trop I, NT-ProBNP, and LVEF at the time of admission. The primary outcome measures were to study the correlation of NT-ProBNP and Trop I and LVEF at the time of admission with mortality, whereas the secondary outcome measure was to study LVEF after ACS up to 1 month. Medians of continuous variables of two groups and three groups were tested.

Results:
The median Trop 1 levels were 12.0, 378.0, and 2454.0 in patients of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), respectively (P = 0.001). The median NT-ProBNP levels were 1027.0, 1494.0, and 3728.5 in patients of UA, NSTEMI and STEMI, respectively (P = 0.002). The median Trop 1 levels were 5433.0, 627.5, and 92.0 in patients whose LVEF was <40%, 40%–50%, and >50%, respectively (P = 0.001). The median NT-ProBNP levels were 14,554.0, 2009.0, and 306.0 in patients whose LVEF was <40%, 40%–50%, and >50%, respectively (P = 0.001). The median Trop 1 levels were 11439.0 and 570.0 in patients who expired and survived, respectively (P = 0.001). The median NT-ProBNP levels were 21047.0 and 1869.5 in patients who expired and survived, respectively (P = 0.001). The median LVEF were 30.0 and 45.0 in patients who expired and survived, respectively (P = 0.001). Trop I showed a significant positive correlation (r = 0.636) with NT-ProBNP levels (P < 0.001).

Conclusion:
Trop I, NT-ProBNP, and LVEF at the time of admission are strong predictors of 1-month mortality in ACS.
Epidemiological study of acute pulmonary embolism in a tertiary care center
Authors: KADIYALA SRI RAMULU , RAZAK ABDUL , NAYAK KRISHNANANDA , RAMACHANDRAN PADMAKUMAR , SAMANTH JYOTHI , PAI M UMESH 
Published: May 2024

Background:
Acute pulmonary embolism remains a significant cause of morbidity and mortality. This study aimed to determine the clinical profile, management, and outcomes of patients with acute pulmonary embolism.

Methods:
This was a retrospective, single-center, and observational study. All consecutive patients with proven diagnosis of pulmonary embolism and treated at a tertiary care center were included in the study based on inclusion and exclusion criteria.

Results:
From January 2012 to May 2018, a total of 304 patients diagnosed with pulmonary embolism were included in the study. Majority of the patients (n = 195; 64.14%) were male. Among included patients, 92 (30.66%) were smokers, and 81 (26.6%) were obese. Dyspnea (98.03%) was the most commonly observed symptom. Of patients who underwent bilateral lower limb venous Doppler, deep vein thrombosis was noted in 172 (56.57%). Electrocardiography confirmed the presence of sinus tachycardia and classical S1Q3T3 pattern in 284 (93.42%) and 79 (25.99%) patients, respectively. Chest X-ray showed dilated main and right pulmonary arteries in 170 (55.92%) patients. Right ventricular dysfunction as detected by echocardiography was observed in 241 (79.28%) patients. Thrombolytic therapy was administered in 158 (51.97%) patients (n = 86 (28.29%) were treated with tenecteplase; n = 72 (23.68%) were treated with streptokinase).

Conclusions:
This study gives an insight into the clinical profile of patients hospitalized with a confirmed diagnosis of acute pulmonary embolism along with treatment and diagnostic approaches adopted by the physician in the Indian scenario.
Evaluation of left ventricular function using speckle tracking echocardiography in patients with severe aortic stenosis with or without symptoms
Authors: YADAV RAHUL , TIWARI BHUWAN CHANDRA , JAMWAL NAVEEN , JHA ASHISH 
Published: May 2024

Background:
Speckle tracking echocardiography (STE) may be useful in early detection of contractile dysfunction in severe aortic stenosis (AS) patients.

Aims and Objectives:
The present study aims to evaluate the global longitudinal strain (GLS), global circumferential strain (GCS), and strain rates in patients with severe AS and the role of STE in predicting the development of symptoms or left ventricular (LV) dysfunction in them.

Methods and Results:
This was a single-centered, prospective, observational study, done at a tertiary care hospital in north India. The study recruited 30 patients with severe AS and 10 healthy controls. Patients underwent two-dimensional echocardiography and STE at baseline and 6 months. Baseline characteristics were similar between the cases and controls. Majority of severe AS patients were symptomatic (n = 24; 80%). LV ejection fraction (LVEF) was similar between cases and controls at baseline and 6 months. Cases had a significantly worse GLS (−-19.3 ± 5.66 vs. -30.4 ± 3.63), GCS (−-29.6 ± 8.48 vs. −-33.6 ± 2.55), and strain rate parameters than the controls at baseline and had a significant decline in these parameters at 6 months. Among 6 asymptomatic patients, 3 developed symptoms and these patients had a significantly greater decline in GLS at 6 months as compared to asymptomatic patients.

Conclusions:
The present study revealed that patients with severe AS had an abnormal GLS and GCS to begin with, which was not picked by LVEF. Further, there was a significant worsening of these STE parameters at 6 months and those who had a greater decline were more likely to develop new symptoms.
Clinical profile, microbiological spectrum, echocardiographic features, and in-hospital outcomes of patients with definite infective endocarditis
Authors: BHOLE CHETAN , VISHWANATHAN SUNITHA , SINGH AMRESH KUMAR , VIJAY S. K. 
Published: May 2024

Background and Objectives:
Infective endocarditis (IE) remains a serious clinical problem with a persistently high morbidity and mortality, despite the availability of improved diagnostic and treatment modalities in the developing world. We examined the microbiological spectrum, clinical profile, echocardiographic features, and in-hospital outcomes of patients with definitive IE.

Materials and Methods:
A total of 20 consecutive cases of definitive IE, admitted between March 2017 and August 2018, at a tertiary care cardiac center (Thiruvananthapuram Medical College, India) were included in the study and followed for 6 months. We compared the clinical profile, other features and outcomes of currently enrolled patients (Group-1) with 10 years back (2007) cohort (Group-2) of IE patients (n = 25) at the same institution.

Results:
The mean age of the Group-1 was 44.7 (±11.6) years, whereas those in Group-2 were 48.6 ± 12.9. The overall male to female sex ratio was 2.2: 1. The rheumatic heart disease (RHD) was the most common predisposing factor accounting for nearly 40% of all cases in both groups, congenital cardiac lesions accounting for 20% in both groups. The most common significant valve lesion was mitral regurgitation (45% vs. 40%P= 0.032). Fever was the most common complaint at the time of hospital admission in both groups (80% vs. 96%). The most common complication was congestive heart failure in both groups (60% vs. 56%). Blood cultures were positive only in 35% patients from Group-1 to 48% from Group-2 (P < 0.01). The mean vegetation size in Group-1 was 7.6 mm and in Group-2 was 10.8 mm (P = 0.04). Patients with large-sized vegetation had increased incidence of heart failure, and embolic phenomena and mortality. Among Group-1, 5 (25%) patients have undergone surgery compared to Group-2, where only 4 (16%) patients have undergone surgery. The overall in hospital mortality in Group-1 was 5 (25%). Out of them, two patients expired after surgery (surgical mortality 40%). In Group-2, mortality was 7 (28%). Out of them, three patients expired after surgery (surgical mortality 42.8%). The majority (53.3%) of patients were in New York Heart Association Class II at the time of discharge.

Conclusions:
The average age of patients presenting with IE in India has increased, while the male predominance is maintained. RHD continues to be the most common predisposing factor. The lower culture positivity rate and lower rates of surgery are worrisome in Indian patients. Despite significant advances in medical technology over the last decade, mortality rate remains the same.
Real-world experience of clinical management with antiplatelet and lipid-lowering therapy in post acute coronary syndrome patients in Indian setting
Authors: HIREMATH M.S. , ROUTRAY S. N. , SHETTY SADANAND R. , JOHN JOHN F. , DAMLE ANIL , PRADHAN AKSHAYA , DHARMADHIKARI ANIRUDDHA , DESAI BHUPEN N. , ABHYANKAR MAHESH V. , REVANKAR SANTOSH 
Published: May 2024

Objective:
The objective is to evaluate the pattern for use of triple-drug therapy (dual antiplatelet therapy [DAPT] and statin) in the management of patients with postacute coronary syndrome (ACS) and associated risk factors in Indian settings.

Materials and Methods:
This was a retrospective multi-centric (n = 63), real-world, cross-sectional study which included patients (aged ≥18 years) diagnosed with an ACS, post-ACS patients from 3 months to 3 years, and receiving DAPT and lipid-lowering agents for ACS. Demographics, baseline characteristics, risk factors, medical history, and therapy details were retrieved from medical charts. Descriptive and comparative analysis for qualitative and quantitative variable was performed.

Results:
A total of 1548 patients with a mean age of 57.4 years were included. Male preponderance was observed across all the age groups. A total of 973 patients were on triple-drug therapy, and the most common triple fixed-dose combination prescribed was rosuvastatin, clopidogrel, and aspirin, among all the groups (age-wise: 76.1%–88.6%; sex-wise: 78.5% and 79.2%; clinical status-wise: 75.7%–81.4%). The majority of patients with non-ST-segment elevation myocardial infarction (43.0%), ST-segment elevation myocardial infarction (42.7%), and unstable angina (40.8%) received triple-drug therapy for >6 to ≤12 months duration. Adverse effect observed in patients receiving triple-drug therapy were skin rash (n = 5), bleeding (n = 2), facial puffing (n = 2), and hematuria (n = 2). A total of 357 patients were undergone switch in DAPT therapy (prasugrel to clopidogrel or ticagrelor to clopidogrel).

Conclusion:
DAPT and statin were the standard of care in majority of ACS patients. Triple fixed-dose combination therapy of aspirin, clopidogrel, and rosuvastatin was the most preferred choice of physicians, for optimal management post-ACS patient in Indian setting.