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Hyderabad andhra Pradesh, India

Vora A.,Kikabai Hospital | Narasimhan C.,Care Hospital
Journal of Association of Physicians of India | Year: 2013

The estimated prevalence of atrial fibrillation (AF) in Europe is 4.5 million and in America is 5.1 million. Arterial thromboembolism, stroke, and heart failure are the some of the most serious complications of AF. There is a fivefold increase in the risk of stroke and the risk of death doubles among patients with AF when compared with the control population. AF-related strokes are more disabling and fatal. The ESC 2010 guidelines and the 2011 ACCF/AHA/HRS update on the management of patients with AF recommend use of adjusted dose warfarin for all patients with a CHA2DS2-VASc score ≥ 1. Though an effective drug, warfarin remains underused due to the several limitations associated with its use. It is limited by a slow onset and offset of action, unpredictable pharmacokinetics, several drug-drug and drug-food interactions and need for regular INR monitoring and dosage adjustments. Newer anticoagulants developed as an alternative to warfarin have better pharmacological and safety profiles and promises effective stroke prevention in AF. © JAPI. Source

Amte R.,Yashoda Hospital | Munta K.,Yashoda Hospital | Gopal P.B.,Care Hospital
Indian Journal of Critical Care Medicine | Year: 2015

Background: Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill. Aim: The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India. Materials and Methods: A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12). Completely filled 242 responses were utilized for comparative and correlation analysis. Results: Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU) followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%), anxiolytic or antidepressants (18%) and smoking (14%). Conclusion: Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour. © 2015, Medical Knowledge. All rights reserved. Source

Srinivasa Roa M.,Care Hospital
Journal of Association of Physicians of India | Year: 2010

The Renin-Angiotensin system (RAS) or the renin-angiotensin-aldosterone system (RAAS) is a major endocrine/paracrine system that regulates blood pressure (BP) via angiotensin release and fluid and electrolyte homoeostasis via aldosterone release. RAAS should be constantly suppressed and any degree of activity may lead to hypertension (HTN) and associated target organ damage. Activation of the RAAS in the pathogenesis of HTN, CVD and renal disease is well documented. Also benefits of inhibition of RAAS, as an effective way to intervene in pathogenesis HTN, CVD and CRF, has been well recognized. RAAS may be blocked by drugs at various points and is important target site for five distinctive classes of hypertensive drugs; beta blockers, renin inhibitors, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBS) and Aldosterone inhibitors. Inhibition of renin activity and the blocked of RAAS cascade at its primary steps, has long been proposed as the optimal means of RAAS Inhibition. renin inhibitor provides more effective means of RAAS Inhibition. Aliskiren is the first in a new class of orally active, non-peptide, low molecular weight direct renin inhibitor (DRI) available for clinical use and potential new approach to the blockade of the RAAS. An average plasma half-life of 23.7 hours (range 20-45 hours), makes drug suitable for once daily administration. BP-Lowering affect of Aliskiren is associated with a decreased, not increased, generation of Ang I, as it blocks generation of Ang I from angiotensinogen, by inhibiting the active enzymatic site of renin. Aliskiren has generally been well tolerated with adverse events and discontinuation rates similar to placebo in most clinical trials. Aliskiren has the potential to be useful in this wide spectrum of conditions and may provide organ protection independent of bP reductions. © JAPI. Source

Sri Nagesh V.,Care Hospital | Kalra S.,BRIDE Hospital
Journal of the Pakistan Medical Association | Year: 2015

Type 1 Diabetes is a complex disorder that is made more complex by the myriad of co-morbid conditions associated with it. Mauriac Syndrome is a well-known but nowadays uncommon condition that presents with growth retardation secondary to poor glycaemic control. Limited Joint Mobility is an often-missed association of diabetes. Its importance lies in the fact that it can cause significant impairment of fine movements in T1DM children. It also indicates poor glycaemic control over a long period of time and can be used as a surrogatemarker for development of diabetic microvascular complications. Anaemia in T1DM is protean and can develop due to a combination of nutritional factors, chronic renal disease, coeliac disease and worm infestation. Management is etiological. Vitamin deficiencies are ubiquitous in T1DM and if left untreated, can lead to neurological, haematological and skeletal dysfunction. The best-known co-morbid conditions are the local site reactions clubbed together under the moniker lipodystrophies. These can be either atrophic or hypertrophic and are usually due to repeated injections at the same site, improper technique and needle re-use. Management is often difficult and they are best prevented by appropriate diabetes education and emphasis on proper injection techniques at the time of T1DMdiagnosis, with periodic reinforcement. Amyloidosis is a little known condition that shares a lot of features in common with the lipodystrophies and often needs to be differentiated from lipohypertrophy. T1DM is a disease which is often associated with a poor quality of life and these co-morbid conditions also need to be treated for effective general and psychological well-being. © 2015, Pakistan Medical Association. All rights reserved. Source

Kafle D.R.,Care Hospital
Nepal Medical College journal : NMCJ | Year: 2010

Patients with diabetes mellitus have 2 to 4 times increased risk for cardiovascular disease than non-diabetic patients. However this excess risk is not fully explained by the traditional cardiovascular risk factors (Hypertension, Hypercholesterolaemia, Smoking and Obesity) which are also associated with diabetes. Fibrinogen has been identified as an independent risk factor for cardiovascular disease and it is associated with traditional cardiovascular risk factors. This is a descriptive analytical cross-sectional study carried out in Tribhuvan University Teaching Hospital (TUTH) medical outpatient department and Medical ward from June 2005 to June 2006. A total of 120 consecutive patients were enrolled; 30 patients having Diabetes. Next 30 patients having both diabetes and coronary artery disease. Thirty patients having only coronary artery disease but no diabetes. And 30 patients (control) not having both diabetes and coronary artery disease. Fibrinogen was found to be significantly higher in patients with diabetes than control. Fibrinogen was significantly higher in diabetic patients with coronary artery disease than those patients who had only diabetes or coronary artery disease (p value<0.01). Source

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