Frequency of Achieving Target INR in Patient on Warfarin for Atrial Fibrillation

Background: Warfarin has long been established as the oral anticoagulant of choice. The benefits of warfarin depend on maintaining the International Normalized Ratio (INR). It has been shown that the optimal INR target range is 2-3 for AF patients. Very less number of patients had been reported to achieve and remain in that target INR range. The prevalence of AF in the general population is about 1.6% in women and 2.4% in men and is generally lower in Asian countries Aim: To determine the frequency of achieving target INR in patient on warfarin for atrial fibrillation. Methodology: This is cross sectional study conducted at national institute of cardio vascular disease, Karachi from 31st May 2016 30th November 2016.The sample size of the study were 111, and nonprobability convenience sampling technique was used. Results: Among study population 61 (54.9%) were male and 50(45%) female patients. Mean duration of atrial fibrillation was 3.44±0.97 years. The mean duration of warfarin taken was 11.34±3.96 months. INR (2-3) target achieved in 72(64.9%) patients. Significant association of achieved INR target was observed with duration of atrial fibrillation, duration of warfarin, hypertension, stroke, and Left ventricular dysfunction. Conclusion: Target of INR was achieved in 64.9% patients when these patients were given warfarin doses of 5.0 to 7.5 mg/day. Keywords: Achieving Target INR, Warfarin, Atrial Fibrillation.

NUTRITIONAL ASSESSMENT AND ASSOCIATED RISK FACTORS OF PATIENTS WITH DYSLIPIDEMIA IN CARDIOVASCULAR DISEASES, KIM’S HOSPITAL, SHEELA NAGAR, VISAKHAPATNAM

Dyslipidemia is one of the major risk factor for cardiovascular disease. Cardiovascular disease (CVD) is a chronic disorder and can lead to mortality. Atherosclerosis is the thickening and narrowing of the arteries; it is due to the formation of plaque in the arteries,which restricts blood flow into various organs.Dyslipidemia denotes elevated levels of one or more types of lipids in the blood. It is an observational study. Study includes 100 samples of age group 30-70 years,of which 50% of the population was female and 50% of the population was male.The samples were collected from KIMS hospital Sheela nagar. Study includes patients with CVD (cardio vascular disease), hypertensive patients, and diabetic patients. Anthropometric measurement, Biochemical parameters, clinical parameters, dietary intake was assessed by 24hours recall method and diet counselling was given.A questionnaire is framed and the data is collected with the help of the questionnaire.The data in the questionnaire includes the general information,patient’s food habits, his interest and habits. Food preferences and likes and dislikes were collected from the patients itself. From the population 32% females,38% males have the habit of walking daily,5% males have the habit of running,3% females and 6% males have the habit of yoga, 15% females and 1% males doesn’t have any of this habit. From the population 11% males consume alcohol, 2% males smoke, 21% males have both the habits, and 16% males don’t have any of the habit. Females are having high levels of cholesterol when compared to males,due to the sedentary lifestyle,whereas males are having high levels of triglycerides,LDL-C,VLDL-C,low HDL-C due to the consumption of alcohol,smoking.

Diabetes and Depression: A Bidirectional Phenomenon

Diabetes mellitus is a strong molecular etiological upstream event that leads to different pathological problems like Cardio-vascular disease, nephropathy, neuropathy, retinopathy, hearing loss, and immunological disturbances, the most common of which is depression. Diabetes and depression relationship is thought to be bidirectional, meaning that depression can lead to diabetes and diabetes can assist the onset of depression. Depression is one of the most overlooked symptoms in diabetes patients, and it is strongly related to a decline in quality of life. Several pathological links are discussed in this review, including dysregulation of the hypothalamic pituitary-adrenal (HPA) axis and neurotransmitter systems, particularly the monoaminergic system, the role of oxidative stress, neuroinflammation, and cell death, impaired neurogenesis and BDNF synthesis, particularly in the hippocampus and prefrontal cortex, brain areas that regulate emotional behaviour, and finally, epigenetic factors.

Role of Adolescence Lifestyle in Cardio Vascular Disease-An Ayurvedic Perspective

Heart disease in the adolescent age group has a unique spectrum. Among all adolescents, risk factors like obesity, an inactive lifestyle, smoking, high blood pressure, and high cholesterol that have a direct relationship on the probability of having cardiac disease later in life. According to Ayurvedic literature, Hridaya is the mula of RasavahaSrotas . The vitiation of this system may lead to diseases such as Sthoulya, Hridroga etc. The role of VyanaVayu and Ojus which contribute significantly to the health and disease of cardio-vascular system. Cardiac risk factors can be prevented or managed by lifestyle including principles of Dinacharya, Ritucharya and sadvrtta. With rapid economic development and increasing urbanization of lifestyle in the past few decades, prevalence of these diseases has reached alarming proportions among Indians in the recent years. So, this presentation is an effort to throw light on the role of adolescence life style in cardiac diseases.

Role of topical beta blockers in regression of infantile capillary hemangioma

Objective: To observe efficacy of Timolol maleate 0.5% by topical and surface application in infantile superficial capillary hemangioma of eyelid. Methods: This multi-centered clinical case series was carried out at Ophthalmology Department of Bilawal Medical College and Institute of Ophthalmology, LUMHS, Jamshoro from November 2019 to May 2020. We included 14 subjects. All the patients were subjected to detailed clinical examination. Before starting the topical beta blockers, the enrolled subjects had obtained the expert opinion by pediatrician to rule out any preexisting developmental cardio vascular disease. Topical beta blockers 0.5% drops were thus started with, against the ongoing finding of superficial capillary hemangioma of eyelid. Results: There was significant regression in size of infantile hemangioma after treating with topical timolol maleate 0.5%. We included 14 subjects in this study. Mean±SD age of patients was 4.94. Complete regression was seen in 08 subjects at the end of 12 weeks (64%) while 03 were completely cured at 08 weeks (21%) and 01 patient lost follow up with us. No significant ocular and systemic side effects were noted. Conclusion: Topical timolol maleate 0.5% can be the first-line treatment modality for superficial capillary hemangiomas due to its better safety and efficacy. doi: https://doi.org/10.12669/pjms.37.7.4317 How to cite this:Junejo MS, Rebecca, Memon MN, Shaikh SP. Role of topical beta blockers in regression of infantile capillary hemangioma. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4317 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Artificial Neural Network for Cardiovascular Disease Prediction

The assurance of coronary ailment a large part of the time depends upon an eccentric mix of clinical and masochist data. Considering this multifaceted nature, there exists a ton of income among clinical specialists and experts with respect to the useful and careful assumption for coronary sickness. In this paper, we cultivate a coronary disease prediction system that can help clinical specialists in expecting coronary ailment status reliant upon the clinical data of patients. Man-made intelligence-gathering strategies are amazingly useful in the clinical field by giving accurate results and quick finishes of ailments. Thusly, these techniques save part of the ideal opportunity for the two trained professionals and patients. The neural associations can be used as classifiers to expect the assurance of Cardiovascular Heart disorder. Keywords: Cardio Vascular disease, Classification, Artificial neural network, Categorical model and Binary model

Associations between smoking and blood-group, and the risk of dyslipidaemia amongst French women

Dyslipidaemia is a major risk factor for cardio-vascular disease, as it promotes atherosclerosis. While cross-sectional studies have identified higher serum cholesterol amongst individuals with the A blood group, there is less evidence from prospective studies whether this translates into a higher risk of dyslipidaemia that requires treatment, nor if this genetic factor interacts with smoking status. This study aimed to prospectively determine potential associations between smoking, ABO blood groups, and risk of incident dyslipidaemia requiring treatment, and to assess associations over strata of blood ABO group. We assessed associations between blood ABO group, smoking and dyslipidaemia in 74,206 women participating in the E3N cohort. We included women who did not have cardiovascular disease at baseline. Logistic regression was used to determine associations between ABO group, smoking and prevalent dyslipidaemia at baseline. Cox proportional hazard models were then used to determine if blood ABO group and smoking were associated with the risk of incident dyslipidaemia, amongst women free of dyslipidaemia at baseline. At baseline 28,281 women with prevalent dyslipidaemia were identified. Compared to the O-blood group, the non-O blood group was associated higher odds of with prevalent dyslipidaemia (ORnon-O = 1.09 [1.06: 1.13]). Amongst the women free of dyslipidaemia at baseline, 6041 incident cases of treated dyslipidaemia were identified during 454,951 person-years of follow-up. The non-O blood groups were associated with an increased risk of dyslipidaemia when compared to the O-group (HRnon-O = 1.16 [1.11: 1.22]), specifically the A blood-group (HRA = 1.18 [1.12: 1.25]). Current smokers were associated with an increased risk of incident dyslipidaemia (HR smokers = 1.27 [1.16: 1.37]), compared to never-smokers. No evidence for effect modification between smoking and ABO blood group was observed (p-effect modification = 0.45), although the highest risk was observed among AB blood group women who smoked (HR = 1.76 [1.22: 2.55]). In conclusion, the non-O blood groups, specifically the A group were associated with an increased risk of dyslipidaemia. Current smokers were associated with a 30% increased risk of dyslipidaemia. These results could aid in personalised approaches to the prevention of cardiovascular risk-factors.

A Review on Prevalence of Medication Adherence among Hypertensive Patients in India

Prevalence of hypertension is increasing exponentially in India. Hence hypertension has become a crucial public health problem in India. High blood pressure (BP) could be a major risk factor for cardio vascular disease and better control can result in prevention of 300,000 of the 1.5 million annual deaths from cardiovascular diseases in India. Various studies among Indian patients evident that not adherence to their antihypertensive regimen and this might end in poor blood pressure control. Adherence to medication among the hypertensive people from the current studies is poor. A comprehensive strategy to enhance adherence to antihypertensive medications is the need of the hour. In this article an attempt has been made to compile all the research evidence on prevalence of Medication Adherence among hypertensive patients in India. Keywords: Medication, Adherence, Prevalence, Hypertension, India.

Shallot skin profilling, computational evaluation of physicochemical properties, ADMET, and molecular docking of its components against P2Y12 receptor

Objectives Medicinal plants are a source of many compounds that are useful in the pharmaceutical field for novel drug development. Polyphenols and the flavonoid group in plants are known to have several activities, such as relieving cardio vascular disease (CVD). The outer skin of the shallot which is disposed of as waste is known to have an antiplatelet activity which was tested in vitro assay. To date, there is no study reported on the ADMET profile and physicochemical properties of the active component of the shallot skins. Methods The extraction of shallot skins was conducted by ultrasonic irradiation using ethanol. The phytochemical screenings were carried out by TLC and color reaction. The profiling of its active ingredient was presented by GC-MS, HPLC and spectrophotometry UV–vis. Whereas their physicochemical properties were analyzed by ChemDraw 17.00 program and the ADMET predictions were studied using pkCSM online tool. The MVD program was operated in the docking study on protein P2Y12 (PDB ID 4PXZ). Results The extract showed the presence of polyphenol, flavonoids, quercetin, natalensine-3,5-dinitrobenzoate; bis[2-(2-fluorophenyl)-6-fluoroquinolin-4-yl]amine, benzo[a]heptalene, N-(trifluoroacetyl) methyl-N-deacethyl-colchicine. The ADMET prediction data displayed that the compounds in the extract have good absorption so that they can be used in the oral and transdermal routes. Some components in the extract have lower MDS than clopidogrel. Conclusions The ultrasonicated shallot skin extract can be used as additional resources of the active pharmaceutical ingredients and to have the potency to be developed as an oral or transdermal preparation.