To Study efficacy and safety of citicoline in acute ischemic stroke

Background: Stroke is a medical emergency with mortality rate higher than most forms of cancer. Acute ischemic stroke is a complex entity with variable clinical manifestations depending on the site and extent of infarction. Besides standard treatment given to the patients, neuroprotection is being targeted to antagonize molecular events that lead to irreversible ischemic injury.Methods: In this study, role of Citicoline in acute ischemic stroke was studied. It was open label study of 12 weeks duration undertaken in Medicine department (emergency unit) of Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Amritsar. Total 40 patients were randomly divided into Group 1 and Group 2. Group 1 received standard treatment for acute ischemic stroke and Group 2 received citicoline in addition to standard treatment. Patients were assessed at admission and after every 24 hours till hospital discharge. Follow up of the patients was done at three weeks, six weeks and twelve weeks after discharge using National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (MRS) and Modified Barthel Index (MBI). The data was statistically analysed using Mann Whitney test.Results: No significant difference was found between two groups with respect to MRS and MBI score throughout the study period. Statistically significant improvement was seen in citicoline group on NIHSS score by 2nd and 3rd day of admission and then on 12th week.Conclusions: Citicoline was found to be safe but with no statistically significant difference in treatment outcome between two groups

Comparative evaluation of voglibose versus pioglitazone on glycaemic control and lipid profile in patients of type 2 diabetes mellitus on glimepiride and metformin in punjabi population

Background: Type 2 Diabetes mellitus (DM) is a heterogeneous group of disorders associated with both microvascular and macrovascular complications. Due to progressive nature of type 2 DM, dual / triple drug therapy produce additive effects, less side effects and allows the use of submaximal doses of individual agents. Therefore, the present study was designed to study the effect of voglibose in comparison to pioglitazone on glycaemic and lipid profile as an add-on drug in patients with DM whose glycaemic status was uncontrolled with glimepiride and metformin.Methods: The present study was open, randomized parallel group comparison of two active treatment groups over a six months period. Sixty patients of either sex in the age group of 30-75 years, suffering from type 2 DM, with FBG> 126 mg/dl and HbA1c between 7- 10 % were selected at random. The effect of voglibose and pioglitazone were observed on various parameters i.e. FBG, PPBG, HbA1c and lipid profile (Total cholesterol, TG, LDL, VLDL).Results: At the end of 6 months it was observed that though both pioglitazone and voglibose reduced FBG, PPBG and HbA1C significantly but pioglitazone caused a significantly greater percentage change in FBG as well as in PPBG whereas the difference in mean percentage change in HbA1C was not significant. Also, fall in total cholesterol, TG, LDL and VLDL was significantly greater with pioglitazone than voglibose. Few side effects were observed with voglibose and not with pioglitazone.Conclusions: Though pioglitazone and voglibose were equally effective in lowering HbA1C levels yet pioglitazone showed better results in improving FBG, PPBG and lipid profile as compared to voglibose. Pioglitazone had minimal side effects as compared to voglibose

Artery of percheron infarct: a case report

Artery of Percheron is a part of the posterior circulation occlusion of which is relatively uncommon. It is classically characterised by bilateral infarcts in areas involving the rostral midbrain and/or ventromedial thalamus best seen by a diffusion-weighted imaging (DWI) sequence using MRI. Clinical presentations are variable and include, amnesic impairment, aphasia, dysarthria, ocular movement disorders, motor deficit and cerebellar signs. Our case was a 60-year-old hypertensive and diabetic male with history of alcohol abuse who presented with sudden derangement of sensorium along with restriction of ocular movements and marked cerebellar signs. The diagnosis of werniche encephalopathy suggested initially by the radiologist was rejected because of the acute onset, history of hypertension and marked cerebellar signs which suggested a cerebrovascular accident. Bilateral infarcts with the occlusion of a single artery i.e. artery of percheron which supplies structures bilaterally can easily be confused with werniche encephalopathy which has similar clinical and radiological picture but are managed on different lines. This diagnosis should be kept in mind in drowsy patients with restricted ocular movements and bilateral thalamic and midbrain hyperintensities

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

To study demographic profile, risk stratification, and response to treatment in chronic myeloid leukemia patients

Background: Chronic myeloid leukemia (CML) is the most common leukemia in India. The annual incidence of CML in India was originally reported to be 0.82.2 per 100,000 population. CML is a clonal disorder that is usually easily diagnosed by the Philadelphia chromosome. The approval of tyrosine kinase inhibitors has significantly reduced the mortality rate associated with CML and revolutionized treatment. Materials and Methods: Eighty patients diagnosed with CML were studied. Investigations were done and with European Treatment and Outcome Study (EUTOS) patients were stratified into low- and high-risk group and then treatment with Imatinib was given to all patients and molecular response was evaluated. Results: In the study population, out of 80 patients, 40 were female and 40 were male with M: F is 1:1. Out of total 80 patients', maximum patients (54) were in 31-60 years age group. Our study showed that the most common symptom of presentation is abdominal discomfort followed by fever. Out of total 80 patients, 25 (31.3%) patients had high EUTOS score and 55 (68.8%) patients had low EUTOS score. On 6 months' follow-up, 36.3% patients had complete molecular response, 16.3% patients had major molecular response and 47.5% patients had no molecular response, but on 12 months' follow-up, 71.3% patients had complete molecular response, 16.25% patients had major molecular response, and 12.5% patients had no molecular response. Conclusion: In this observational study, we found a significant correlation between EUTOS score and molecular response at 6 months and 12 months follow-up after Imatinib therapy

Oxidative Stress: An Effective Prognostic Tool for an Early Detection of Cardiovascular Disease in Menopausal Women

Background. Menopause, a form of reproductive aging, is marked by many hormonal variations which cause imbalance in the oxidative processes resulting in onset of endothelial dysfunction leading to cardiovascular disease (CVD). We aimed to analyze the effect of oxidative stress in an early detection of CVD in all menopausal women both normolipidemic and hyperlipidemic. Methods and Results. Study included 523 menopausal women (265 CVD and 258 non-CVD). They were screened for lipid profile, serum malondialdehyde (MDA), serum LDL carbonyl protein, and serum superoxide dismutase (SOD). Pearson’s correlation was observed between MDA and atherogenic index of plasma (AIP) in both normolipidemic (r=0.650; p<0.001) and hyperlipidemic (r=0.207; p<0.01) CVD group as compared to non-CVD menopausal women. Significant correlation was also observed between LDL carbonyl content and AIP in normolipidemic (r=0.650; p<0.001) and hyperlipidemic (r=0.248; p<0.01) CVD menopausal women as compared to non-CVD ones. Conclusion. Strong correlation between atherogenic index of plasma and oxidative stress in CVD menopausal women reveals oxidative stress as an effective prognostic tool for an early detection of cardiovascular risk

Artery of percheron infarct: a case report

Artery of Percheron is a part of the posterior circulation occlusion of which is relatively uncommon. It is classically characterised by bilateral infarcts in areas involving the rostral midbrain and/or ventromedial thalamus best seen by a diffusion-weighted imaging (DWI) sequence using MRI. Clinical presentations are variable and include, amnesic impairment, aphasia, dysarthria, ocular movement disorders, motor deficit and cerebellar signs. Our case was a 60-year-old hypertensive and diabetic male with history of alcohol abuse who presented with sudden derangement of sensorium along with restriction of ocular movements and marked cerebellar signs. The diagnosis of werniche encephalopathy suggested initially by the radiologist was rejected because of the acute onset, history of hypertension and marked cerebellar signs which suggested a cerebrovascular accident. Bilateral infarcts with the occlusion of a single artery i.e. artery of percheron which supplies structures bilaterally can easily be confused with werniche encephalopathy which has similar clinical and radiological picture but are managed on different lines. This diagnosis should be kept in mind in drowsy patients with restricted ocular movements and bilateral thalamic and midbrain hyperintensities

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)