Comparison of anti-thrombotic strategies using Bivalirudin, Heparin plus Glycoprotein IIb/IIIa inhibitors and Unfractionated Heparin Monotherapy for patients undergoing percutaneous coronary intervention – A single centre observational study

Aims: The study was planned to compare Anti-thrombotic strategies for patients undergoing PCI in a real world population with an emphasis on occurrence of major bleeding, composite ischemic end points and economic outcomes. Methods: The present study is a single center, prospective, observational study in consecutive patients undergoing PCI at Fortis Escorts Heart Institute (FEHI) and describes Authors' experience with three different Anti-Thrombotic Strategies in a real world population. Patients were consecutively enrolled in the study and the choice of Anti-thrombotic strategy was left to individual operator(s) based on their own clinical judgment and patient's affordability. No specific inclusion/exclusion criteria were specified on the choice of Anti-Thrombotic Strategy. Results: A total 1453 patients were consecutively enrolled into the study and were followed telephonically after 30 days. 252 patients were treated with Bivalirudin (Angiomax) during PCI (17.3%), 430 (29.6%) patients were treated with Heparin plus GPI & remaining 771 (53.1%) were treated with Heparin monotherapy. Incidence of major bleeding was lowest in patients treated with Bivalirudin (1.59%) when compared to Heparin plus GPI (3.49%) and Heparin monotherapy (5.97%), p = 0.005 Bivalirudin vs. Heparin Monotherapy, and p = 0.145, Bivalirudin vs. Heparin + GPI. No bleeding was observed in STEMI patients treated with Bivalirudin compared to 7.4% in patients treated with GPI and 14.3% in patients treated with UFH. Similarly non-access site bleeding was lowest in patients treated with Bivalirudin. Only 4 patients (1.6%) treated with Bivalirudin required Blood transfusion compared to 25 in Heparin plus GPI (5.8%) and 38 (5%) in Heparin Monotherapy arm. In Composite Ischemic end-points, no “All-cause Mortality” was observed in Bivalirudin group compared to 2.8% in Heparin plus GPI. Early stent thrombosis was seen in 1 patient with Heparin plus GPI and none with Heparin monotherapy and Bivalirudin group. None of the patients underwent TLR (target lesion revascularization) and TVR (target vessel revascularization) within 30 days post procedure other than one early stent thrombosis reported with Heparin plus GPI. Cost of blood product transfusion was lower with Bivalirudin as compared to Heparin plus GP IIb/IIIa arm (p = 0.01) and with Heparin alone (p = 0.001). Due to lower complications including blood transfusions and reduced hospital stay in Bivalirudin group, these benefits outweigh the incremental cost due to higher acquisition cost of the drug. Conclusion: Bivalirudin use during PCI is associated with a distinct advantage of having lower access site and non-access site bleeding without compromising on the efficacy. We observed a reduction in blood transfusions, hospital stay and mortality for patients treated with Bivalirudin compared with Heparin plus GPI or Heparin Monotherapy. Bivalirudin can be safely adopted into our Institutional protocol for the treatment of high risk PCI such as STEMI, ACS, and Complex elective PCI

Hypothyroidism in acute coronary syndrome – A prospective Indian study

Background: Evidence suggests that hypothyroidism may be associated with an increased risk of acute coronary syndrome (ACS).The data regarding the influence of hypothyroidism on cardiovascular disease in the Asian population is conflicting. Therefore, we undertook this study to assess the overall prevalence of hypothyroidism in Acute Coronary Syndrome (ACS) patients and determine if there is a relationship between hypothyroidism, both sub-clinical and overt and other significant risk factors of ACS in an Indian population. Methods: We studied 487 hospitalized patients between March 2018 and February 2021 with a diagnosis of ACS to determine the prevalence of hypothyroidism, both clinical and sub-clinical and their relationship with other known coronary risk factors. Thyroid function Tests - free T3, free T4 and TSH were collected from all the patients within 24 h of their admission to the coronary care unit (CCU) of 2 major hospitals in New Delhi and Imphal (Manipur). Results: Subclinical hypothyroidism was prevalent in 44 (9 %), followed by overt hypothyroidism in 25 (5.2 %).Subclinical hypothyroidism was more common in females, whereas overt hypothyroidism was more common in males. ST Elevation Myocardial Infarction (STEMI) (52 %), followed by Non-ST-Elevation Myocardial Infarction (NSTEMI) (25 %), was the commonest diagnosis at presentation. Patients with overt hypothyroidism showed a higher proportion of increased triglyceride levels.Patients with hypothyroidism had no differences in the prevalence of concomitant diabetes hypertension and other coronary risk factors. Conclusions: Patients with ACS without known thyroid disorders should be screened for hypothyroidism since it is found frequently. There might be a case to treat their thyroid dysfunction appropriately

Earth Mover’s Distance-Based Tool for Rapid Screening of Cervical Cancer Using Cervigrams

Cervical cancer is a major public health challenge that can be cured with early diagnosis and timely treatment. This challenge formed the rationale behind our design and development of an intelligent and robust image analysis and diagnostic tool/scale, namely “OM—The OncoMeter”, for which we used R (version-3.6.3) and Linux (Ubuntu-20.04) to tag and triage patients in order of their disease severity. The socio-demographic profiles and cervigrams of 398 patients evaluated at OPDs of Batra Hospital & Medical Research Centre, New Delhi, India, and Delhi State Cancer Institute (East), New Delhi, India, were acquired during the course of this study. Tested on 398 India-specific women’s cervigrams, the scale yielded significant achievements, with 80.15% accuracy, a sensitivity of 84.79%, and a specificity of 66.66%. The statistical analysis of sociodemographic profiles showed significant associations of age, education, annual income, occupation, and menstrual health with the health of the cervix, where a p-value less than (<) 0.05 was considered statistically significant. The deployment of cervical cancer screening tools such as “OM—The OncoMeter” in live clinical settings of resource-limited healthcare infrastructure will facilitate early diagnosis in a non-invasive manner, leading to a timely clinical intervention for infected patients upon detection even during primary healthcare (PHC)

Earth Mover’s Distance-Based Tool for Rapid Screening of Cervical Cancer Using Cervigrams

Cervical cancer is a major public health challenge that can be cured with early diagnosis and timely treatment. This challenge formed the rationale behind our design and development of an intelligent and robust image analysis and diagnostic tool/scale, namely “OM—The OncoMeter”, for which we used R (version-3.6.3) and Linux (Ubuntu-20.04) to tag and triage patients in order of their disease severity. The socio-demographic profiles and cervigrams of 398 patients evaluated at OPDs of Batra Hospital & Medical Research Centre, New Delhi, India, and Delhi State Cancer Institute (East), New Delhi, India, were acquired during the course of this study. Tested on 398 India-specific women’s cervigrams, the scale yielded significant achievements, with 80.15% accuracy, a sensitivity of 84.79%, and a specificity of 66.66%. The statistical analysis of sociodemographic profiles showed significant associations of age, education, annual income, occupation, and menstrual health with the health of the cervix, where a p-value less than (<) 0.05 was considered statistically significant. The deployment of cervical cancer screening tools such as “OM—The OncoMeter” in live clinical settings of resource-limited healthcare infrastructure will facilitate early diagnosis in a non-invasive manner, leading to a timely clinical intervention for infected patients upon detection even during primary healthcare (PHC).https://doi.org/10.3390/app1209466

Earth Mover&rsquo;s Distance-Based Tool for Rapid Screening of Cervical Cancer Using Cervigrams

Cervical cancer is a major public health challenge that can be cured with early diagnosis and timely treatment. This challenge formed the rationale behind our design and development of an intelligent and robust image analysis and diagnostic tool/scale, namely &ldquo;OM&mdash;The OncoMeter&rdquo;, for which we used R (version-3.6.3) and Linux (Ubuntu-20.04) to tag and triage patients in order of their disease severity. The socio-demographic profiles and cervigrams of 398 patients evaluated at OPDs of Batra Hospital &amp; Medical Research Centre, New Delhi, India, and Delhi State Cancer Institute (East), New Delhi, India, were acquired during the course of this study. Tested on 398 India-specific women&rsquo;s cervigrams, the scale yielded significant achievements, with 80.15% accuracy, a sensitivity of 84.79%, and a specificity of 66.66%. The statistical analysis of sociodemographic profiles showed significant associations of age, education, annual income, occupation, and menstrual health with the health of the cervix, where a p-value less than (&lt;) 0.05 was considered statistically significant. The deployment of cervical cancer screening tools such as &ldquo;OM&mdash;The OncoMeter&rdquo; in live clinical settings of resource-limited healthcare infrastructure will facilitate early diagnosis in a non-invasive manner, leading to a timely clinical intervention for infected patients upon detection even during primary healthcare (PHC)

Safety and Effectiveness of Bone Marrow Cell Concentrate in the Treatment of Chronic Critical Limb Ischemia Utilizing a Rapid Point-of-Care System

Critical limb ischemia (CLI) is the end stage of lower extremity peripheral vascular disease (PVD) in which severe obstruction of blood flow results in ischemic rest pain, ulcers and/or gangrene, and a significant risk of limb loss. This open-label, single-arm feasibility study evaluated the safety and therapeutic effectiveness of autologous bone marrow cell (aBMC) concentrate in revascularization of CLI patients utilizing a rapid point-of-care device. Seventeen (17) no-option CLI patients with ischemic rest pain were enrolled in the study. Single dose of aBMC, prepared utilizing an intraoperative point-of-care device, the Res-Q™ 60 BMC system, was injected intramuscularly into the afflicted limb and patients were followed up at regular intervals for 12 months. A statistically significant improvement in Ankle Brachial Index (ABI), Transcutaneous Oxygen Pressure (TcPO2), mean rest pain and intermittent claudication pain scores, wound/ ulcer healing, and 6-minute walking distance was observed following aBMC treatment. Major amputation-free survival (mAFS) rate and amputation-free rates (AFR) at 12 months were 70.6% and 82.3%, respectively. In conclusion, aBMC injections were well tolerated with improved tissue perfusion, confirming the safety, feasibility, and preliminary effectiveness of aBMC treatment in CLI patients

Blood pressure related to age: The India ABPM study

The present paper reports trends in office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) with age in a large multi‐center Indian all comers’ population visiting primary care physicians. ABPM and OBPM data from 27 472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analyzed and compared. Individual differences between OBPM and ABPM patterns were compared for patients according to 10‐year age categories. Results showed that systolic (S) BP values started to increase with age from the age of 40, BP variability (SD) increased from the age of 30 years. Diastolic (D) BP values started to decrease from the age of 50 years. Mean OBPM values were higher than daytime ABPM values (all P < .001) in all age‐groups. The prevalence of white coat hypertension (WCH) and masked hypertension (MH) was based on OBPM and daytime, 24‐hour, and nighttime average BPs together. WCH decreased with age from 15.1% and 12.4% in treated and untreated subjects at the youngest age to 7.2% and 6.9% in the oldest age, respectively. MH prevalence was higher for untreated than for treated subjects but remained similar for all age‐groups (range of 18.6%‐21.3%). The prevalence of reverse dippers increased with age from the youngest to oldest group with 7.3%‐34.2% (P < .001 for trend). Dippers prevalence decreased from 42.5% to 17.9% from the youngest to oldest age‐groups, respectively (P < .001 for trend). These findings confirm that BP patterns show clear differences in trends with age, particularly regarding nighttime BP

Blood pressure related to age: The India ABPM study

The present paper reports trends in office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) with age in a large multi‐center Indian all comers’ population visiting primary care physicians. ABPM and OBPM data from 27 472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analyzed and compared. Individual differences between OBPM and ABPM patterns were compared for patients according to 10‐year age categories. Results showed that systolic (S) BP values started to increase with age from the age of 40, BP variability (SD) increased from the age of 30 years. Diastolic (D) BP values started to decrease from the age of 50 years. Mean OBPM values were higher than daytime ABPM values (all P < .001) in all age‐groups. The prevalence of white coat hypertension (WCH) and masked hypertension (MH) was based on OBPM and daytime, 24‐hour, and nighttime average BPs together. WCH decreased with age from 15.1% and 12.4% in treated and untreated subjects at the youngest age to 7.2% and 6.9% in the oldest age, respectively. MH prevalence was higher for untreated than for treated subjects but remained similar for all age‐groups (range of 18.6%‐21.3%). The prevalence of reverse dippers increased with age from the youngest to oldest group with 7.3%‐34.2% (P < .001 for trend). Dippers prevalence decreased from 42.5% to 17.9% from the youngest to oldest age‐groups, respectively (P < .001 for trend). These findings confirm that BP patterns show clear differences in trends with age, particularly regarding nighttime BP

Blood pressure and heart rate related to sex in untreated subjects:the India ABPM study

Women are underrepresented in groups of patients seeking hypertension care in India. The present paper reports trends in office and ambulatory blood pressure measurement (OBPM, ABPM) and 24‐h heart rate (HR) with sex in 14,977 subjects untreated for hypertension (aged 47.3 ± 13.9 years, males 69.4%) visiting primary care physicians. Results showed that, for systolic blood pressure (SBP), females had lower daytime ABPM (131 ± 16 vs. 133 ± 14 mm Hg, P < .001) but higher nighttime ABPM (122 ± 18 vs. 121 ± 16 mm Hg, P < .001) than males. Females had higher HR than men at daytime (80 ± 11 vs 79 ± 11.5 bpm) and nighttime (71 ± 11 vs 69 ± 11), respectively (all P < .001). Dipping percentages for SBP (7.4 ± 7.3 vs 9.3 ± 7.4%), DBP (10.1 ± 8.6 vs. 12.3 ± 8.9%), and HR (10.7 ± 7.9 vs. 12.8 ± 9.2%) were lower (P < .001) for females than for males, respectively. Females more often had isolated nighttime hypertension as compared to males (14.9%, n = 684% vs 10.6%, n = 1105; P < .001). BP patterns and HR showed clear differences in sex, particularly at nighttime. As females were more often affected by non‐dipping and elevated nighttime SBP and HR than males, they should receive ABPM, at least, as frequently as men to document higher risk necessitating treatment