Reliability of ankle brachial index in patients with neurological deficits on ischemic episode of the limbs following Burgers exercises: open labelled clinical trial

Background: Peripheral arterial disease (PAD) is associated with significant morbidity and mortality and is an important marker of subclinical coronary heart disease. In some studies it has been found that surgical intervention alone or physical training alone does not provide good results. Aim of the study was to assess the reliability of ankle brachial index in patients with neurological deficits on ischemic episode of limbs following Burgers exercises.Methods: It was an open labelled clinical trial. Total 35 patients of both male and females were included in this open labelled clinical trial. Two measuring technique ABI and VAS, one exercise program, unsupervised home exercise program and patients advice was part of procedure. Intervention was given at 1st day, 3rd month and 6th month.Results: The study proves  that VAS,  ABI  showed  statistical significant difference when analyzed   between 1st  day to 3rd month, 1st day to 6th month  and  3rd month to 6th month  with ‛ p ’ value <0.0001.Conclusions: Physical therapy in the form of Burger’s exercise with life style modification is significant in improving quality of life in the form of reducing severity of claudication pain and improving walking distance. Therefore the present study concludes that ABI is a reliable, simple, safe and standard gold diagnostic tool in assessing ischemic episode of the limbs in patients with neurological deficits following burgers exercises.

Association between elevated serum uric acid levels and islet beta cell function indices in newly diagnosed type 2 diabetes mellitus-a one year cross sectional study at tertiary care center

Background: Serum uric acid (SUA) has been reported as a risk factor for type 2 diabetes mellitus (T2DM). Even though various studies concluded that SUA plays an essential role in DM onset, association between SUA and pancreatic islet β cell function and the effect of gender and body mass index (BMI) on it in is still unclear. Methods: A hospital based one-year cross-sectional study was conducted and required data was collected from 76 patient who were newly diagnosed T2DM. All patients were investigated for SUA, and homeostasis model assessment-insulin resistance (HOMA-IR) was calculated using the HOMA2 calculator. Results: Mean SUA level among the males was 4.65±1.81 mg/dl and among the females was 4.31±1.94 mg/dl. β pancreatic cell function index was estimated using HOMA-IR. Mean HOMA-IR level among the male study population was 5.01±7.44 and 5.02±4.63 among the females. A positive and significant correlation was observed between SUA and HOMA-IR (r=0.2283, p=0.0489) at 5% level, and was more pronounced among the female population (r=0.5127, p=0.0175). Correlation between HOMA-IR and BMI was found to be positive and significant (r=0.4948, p=0.0001). On plotting multiple regression analysis, coefficient of determination (R²) was 0.8374 (p&lt;0.05), indicating significant contribution of all variables when combined towards HOMA-IR. Conclusions: Present study demonstrates that SUA harbours a positive and significant correlation with pancreatic islet β cell function index among newly diagnosed T2DM patients and is influenced by gender and BMI.

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

BACKGROUND: The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012–2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3–2.3) versus 2.3 (IQR 1.8–2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32–9.35) vs 4.34 (4.16–4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF

Assessment of anxiety and behavior changes on digital education in undergraduate dental students during COVID-19 pandemic

Context: Due to the COVID-19 pandemic, to avoid community spread of the disease, various academic institutions were closed to prevent infecting the students. Hence their relocation from the institution resulted in online academic learning. Reports indicated that the students undergoing online academic learning experienced distress in the form of anxiety, anger and insomnia. Aims: The aim of this study was to assess the changes in mental attitude, behavioral pattern, and anxiety level along with the impact of online education on academics so as to receive suggestions regarding digital education from undergraduate dental students. Settings and Design: An observational, cross-sectional study was conducted formulating online semi-structured, open-ended questionnaires, to obtain inputs regarding digital education using Google Forms and the snowball sampling method. Subjects and Methods: The data collection was initiated on August 6 at 4 PM IST and closed on August 13, 2020, at 4 PM IST. We received the response from 488 students from five dental institutions of Karnataka, Maharashtra, and Andhra Pradesh. Statistical analysis was performed using Microsoft Excel for obtaining an overall percentage of mental attitude, anxiety, behavior changes, and academics. IBM SPSS Statistics 20 software was used to evaluate correlation among all parameters with the analysis of variance test. Results: A statistically significant association was seen between digital education with anxiety (P = 0.015), behavior changes (P = 0.000), and academics (P = 0.000). Students contributed positive inputs to enhance the learning outcome in academics on the digital platform. Conclusions: Online academic sessions have eased the learning process to a certain extent, but this mode of education needs more refinement in the form of clinical demonstration videos, sharing of study material, well-planned and spaced definite timetable, and postsession evaluation. These suggestions were put forth by the students as feedback to make the experience entirely stress-free and aid their learning process

A study of clinical profile in different serological diagnostic parameters of dengue fever

Background and Objectives: Dengue fever a mosquito borne viral infection poses an serious situation due to lack of antiviral drugs or vaccine.[1] Worldwide, an estimated 2.5 billion people are at risk of infection.[2] It is estimated that more than 50 million infections occur each year, of which 500,000 hospitalizations are of dengue haemorrhagic fever with the case fatality rate exceeding 5% in some areas. The objective of this research was to study the clinical profile in different serological diagnostic parameters of dengue fever. Methodology: The present study was conducted in Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum In patients with dengue fever from January 2014 to December 2014.The study design was one year cross-sectional study. A total of 180 dengue fever patients were studied. Results: Out of 180 patients 72.22% of the patients were males and male to female ratio was 2.6: 1 In the study all the patients presented with fever (100%). In this study 127 (70.56%) patients presented with melaena, the p value was 0.025 In the present study 113 (62.78%) patients presented with rash. p = 0.045. Platelet count of 20000 to 49999/cumm was in 51 patients (28.33%) with a p = 0.010. In this study serum creatinine levels were raised in 15% of the patients and the value was p = 0.029 Conclusion and Interpretation: The findings of this study highlight that clinical profile of dengue fever based on clinical features viz. rash, and laboratory parameters that is, platelet count, serum creatinine which showed significant variations in different dengue serological tests