Mamata Medical College

Abstract Background Bronchiectasis is a chronic progressive lung disease characterized by cough, sputum production and recurrent respiratory infections and gradual airway damage. This is seen millions globally and it causes decreased Quality of Life, Significant morbidity and accelerated mortality. The pathogenesis involves a vicious cycle of neutrophilic inflammation, impaired mucociliary clearance and progressive structural lung damage. The current standard of care involves airway clearance, antibiotics and symptomatic care, but hardly none focuses on underlying inflammatory pathogenesis. Neutrophil serine proteases are activated by dipeptidyl peptidase-1 (DPP-1) during neutrophil maturation and they disrupt protease-antiprotease balance and perpetuates inflammation. DPP-1 inhibitors interfere in this pathway and therefore they break the vicious cycle and potentially improve clinical outcomes in bronchiectasis patients. Methods We searched PubMed, Embase, Google Scholar, and Cochrane databases for studies evaluating Efficacy and safety of DPP-1 inhibitors in bronchiectasis patients. Three randomized controlled trials met inclusion criteria. Data were pooled using inverse variance weighting method. Random-effects model was used and Forest plots were generated to illustrate pooled effect estimates. Analysis was done using R software(version 4.5.0). Results A total of 1502 patients from three studies were included. DPP-1 inhibitors significantly decreased annual pulmonary exacerbation rates (IRR:0.75;95% CI:0.59-0.97;p=0.0267) and prolonged the time to first exacerbation during treatment(HR:0.66;95% CI:0.46-0.96;p=0.0291) compared to placebo. Many patients in the treatment group remained exacerbation-free compared to placebo, but its statistical significance is not established (RR:1.42;95% CI:0.96-2.08;p=0.0756).Quality of life score significantly improved from baseline in the treatment group (MD:2.69;95% CI:0.66-4.72;p=0.0094). Overall adverse events (RR:0.97;95% CI:0.92-1.01;p=0.1417), serious adverse events (RR:0.84;95% CI:0.68-1.04;p=0.1054) and deaths (RR:0.70;95% CI:0.22-2.18;p=0.5348) slightly favoured the treatment group, but they are not statistically significant. DPP-1 inhibitors particularly increased the risk of dermatological adverse events (RR:2.51;95% CI:1.28-4.91;p=0.0075). Conclusion DPP-1 inhibitors significantly reduced exacerbation rates and improved quality of life in bronchiectasis patients. They also showed favorable safety profile, except for few dermatological conditions which should be carefully monitored for. Future research should focus on optimal dosing strategies, long term safety profile and identifying patient subgroup who benefit most from DPP-1 inhibitors. This abstract is funded by: None

BACKGROUND:Right atrial appendage (RAA) pacing remains the default atrial lead position despite evidence that non-physiological atrial activation promotes interatrial dyssynchrony. Bachmann's bundle pacing (BBp) targets the interatrial conduction pathway. We evaluated whether BBp improves electrophysiologic markers of atrial synchrony and whether this is accompanied by a reduction in atrial fibrillation (AF) incidence compared with RAA pacing. METHODS:Systematic review and meta-analysis of studies comparing BBp with RAA pacing. PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and reference lists were searched (December 2025). PRIMARY OUTCOME:P-wave duration change. Secondary: AF incidence. SAFETY:lead dislodgement. Random-effects (REML) models. RESULTS:Eight studies comprising 731 patients were analyzed. BBp was associated with a consistent reduction in P-wave duration (primary analysis, 5 independent-group studies: MD -34.61 ms; 95% CI -39.84 to -29.38; p < 0.001; I2 = 0%; 6-study sensitivity including Vedage et al.: MD -35.24 ms; I2 = 0%), indicating a shortening of global atrial activation time. BBp was also associated with a lower AF incidence across three RCTs (RR 0.59; 95% CI 0.37-0.94; p = 0.026); however, this estimate was imprecise and sensitive to removal of the dominant contributing trial. Atrial lead dislodgement was rare and events were insufficient for formal pooled analysis; no excess dislodgement signal was observed, but comparative safety remains uncertain given event sparsity. CONCLUSIONS:BBp consistently reduced P-wave duration across diverse paced populations and generated a fragile signal toward lower AF incidence. Comparative lead safety is uncertain due to sparse events. These findings support investigation in prospective trials but do not justify immediate practice change. PROSPERO REGISTRATION:CRD420261282981.

Background: Non-group 1 pulmonary hypertension, also known as secondary pulmonary hypertension (SPH), is predominantly observed among females. However, there is a significant lack of data concerning factors associated with hospitalization among patients diagnosed with SPH. This study aims to provide clinicians with vital insights for the identification of high-risk groups and for the more effective management of contributory risk factors within the female population affected by SPH. Methods: Using the 2019 National Inpatient Sample, we identified female admissions with SPH (n = 648,190), accounting for 3.8% of the total 17,236,228 female admissions. An Artificial Neural Network (ANN) analysis was conducted to evaluate predictive factors. We randomly allocated 3,319,543 patients into training and testing datasets at a ratio of 70:30, comprising 2,323,696 (70%) for training and 995,847 (30%) for testing, to calibrate and validate the performance of the ANN algorithm. Model performance was assessed by comparing misclassification rates between training and testing sets and by the area under the receiver operating characteristic curve (AUC); only internal validation was performed. Results: Females hospitalized with SPH were generally of older age, with a median of 75 years compared to 58 years, and more frequently identified as White (67.7% versus 65.5%) or Black (20.5% versus 15.5%) relative to those without SPH. They also demonstrated a higher prevalence of most atherosclerotic cardiovascular disease (ASCVD) risk factors or their equivalents, including complicated hypertension (50.6% versus 17.8%), diabetes with chronic complications (30.6% versus 13.7%), and hyperlipidemia (50.8% versus 29.2%), as well as other comorbidities such as COPD (43.4% versus 20.2%) and CKD (43.3% versus 14.0%), and exhibited increased all-cause mortality (4.5% versus 1.8%) (p < 0.001). Our ANN model achieved an AUC of 0.823, indicating good predictive capability. The rates of incorrect predictions were comparable in both the testing and training cohorts, at 3.8% each. The factors most strongly associated with a coded SPH diagnosis included age at admission, complicated hypertension, chronic kidney disease, chronic obstructive pulmonary disease, uncomplicated hypertension, prior VTE, race, arthropathies, and AIDS. Conclusions: Our ANN model identified demographic and comorbidity factors associated with a coded SPH diagnosis among hospitalized females, with good discrimination (AUC = 0.823). Because the model classifies the presence of an existing diagnosis rather than predicting future hospitalization, and was validated only internally, external and prospective validation is required before clinical application. Once validated, these factors could support individualized, sex-specific risk stratification for high-risk female populations, consistent with the goals of personalized medicine.

Background: Smartphone use is pervasive in young adults and frequently extends into the pre-sleep period. Prolonged and late-night screen exposure can disrupt sleep initiation and continuity and contribute to next-day sleepiness. Objectives: To evaluate the association between daily smartphone screen time, sleep quality, and daytime alertness among young adults. Methods: This observational study was conducted among 100 adults at the Department of Physiology, Mamata Medical College, Khammam, Telangana, India, between January and December 2025. Daily screen time and bedtime phone-use behaviors were recorded. Sleep quality and daytime sleepiness were assessed using standardized questionnaires. Associations were examined across screen-time categories, along with correlation and multivariable analyses. Results: The mean age was 22.9 ± 3.8 years, and 54.0% were female. Mean smartphone screen time was 5.1 ± 2.0 hours/day; 76.0% used phones within 1 hour before sleep, and 41.0% frequently used them in bed. Mean PSQI rose from 4.6 ± 1.9 in those with <3 hours/day screen time to 8.3 ± 2.6 in those with >7 hours/day. Poor sleep increased from 30.0% to 100.0%, and short sleep from 35.0% to 82.4% [p < 0.001]. Mean ESS was 9.6 ± 3.8; screen time correlated with PSQI [r = 0.49] and ESS [r = 0.36], independently predicting poor sleep and daytime sleepiness significantly. Conclusion: Higher daily smartphone screen time and near-bedtime use were associated with poorer sleep quality and reduced daytime alertness in young adults. Targeted sleep-hygiene counselling focused on screen-time timing and duration is warranted in college and workplace health programs. Recommendations: Practical steps include keeping the phone away from the bed, stopping screen use at least 60 minutes before sleep, enabling night-mode settings, and replacing late-night scrolling with a low-stimulation wind-down routine.

Introduction Chemotherapy-related cardiotoxicity, leading to reduced Left Ventricular Ejection Fraction (LVEF), remains a significant clinical challenge for breast cancer patients. Cardioprotective medications have been proposed to mitigate these effects; however, evidence on the optimal therapeutic option is unclear. Hypothesis We hypothesized that certain cardioprotective medications provide superior efficacy in preserving LVEF among breast cancer patients undergoing chemotherapy compared to placebo. Method A systematic search of PubMed, Cochrane, Embase, Scopus, and WOS databases identified randomized controlled trials (RCTs) evaluating the efficacy and safety of cardioprotective drugs—including beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and statins—in breast cancer patients undergoing chemotherapy. Frequentist network meta-analysis was performed using the ‘netmeta’ package in Rstudio (version 4.4.2). We applied a random-effects model to calculate mean differences (MD) with 95% confidence intervals (CI). Treatments were ranked by the surface under the cumulative ranking curve (SUCRA); higher SUCRA scores reflect greater effectiveness. Result Eighteen RCTs comprising 2223 breast cancer patients on chemotherapy were included. Spironolactone demonstrated the highest efficacy in preserving LVEF (MD: -12.80%, 95% CI: [-17.62; -7.98], SUCRA: 0.9935, P<0.0001), followed by Nebivolol (MD: -7.30%, 95% CI: [-12.34; -2.26], SUCRA: 0.8721, P=0.0045) and the Lisinopril+Bisoprolol combination (MD: -5.25%, 95% CI: [-10.13; -0.37], SUCRA: 0.7512, P=0.0350). Bisoprolol (MD: -3.03%, SUCRA: 0.5561, P=0.0190) and Candesartan (MD: -2.93%, SUCRA: 0.5524, P=0.0013) showed moderate yet significant benefits. Metoprolol (MD: 0.83%, P=0.5818), Carvedilol (MD: 0.99%, P=0.0658), and Perindopril (MD: -1.51%, P=0.3533) did not significantly outperform placebo. Conclusion Spironolactone, Nebivolol, and Lisinopril+Bisoprolol showed significant protective effects on LVEF in breast cancer patients receiving chemotherapy. Spironolactone was identified as the most effective option, whereas Carvedilol, Metoprolol, and Perindopril had limited benefit. These findings support using Spironolactone, Nebivolol, or combination therapies for cardioprotection during chemotherapy.