A BSTRACT Aims: To evaluate the impact of cardiac rehabilitation (CR), including exercise training, on quality of life (QOL) in adults with cardiac implantable electronic devices (CIEDs). Methods: A literature search was conducted on August 1, 2025, using PubMed, Web of Science, and Cochrane Register of Controlled Trials through Evidence-Based Medicine Reviews. We included randomized controlled trials written in English that involved CR during the maintenance phase, including exercise training, in adults with CIEDs and assessed QOL at two time points. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials. The meta-analysis included pooled analysis of standardized mean differences (SMDs) and analysis limited to the physical component score (PCS)/mental component score (MCS) domains of Short Form-36 (SF-36). Results: Among 12 studies identified involving 922 participants, seven studies (469 participants) were finally included in the meta-analysis. Three studies showed significant improvement in QOL in the CR group. However, the meta-analysis of SMD showed that the effect of CR on QOL improvement was not significant (SMD = 0.17, 95% confidence interval [CI]: −0.31–0.65), with moderate heterogeneity ( I 2 = 54%). Meta-analysis of the SF-36 also showed no significant effect of CR on QOL (PCS: mean difference [MD] =0.22, 95% CI: −1.96–2.40; MCS: MD = 0.30, 95% CI: −3.70–4.29. Conclusions: The results of the present meta-analysis showed no statistically significant benefits of CR for adults with CIEDs. However, due to several limitations in the studies, further research is needed to clarify the effects of CR on QOL in this population.
A BSTRACT Background: Pulmonary embolism (PE) is one of the greatest diagnostic challenges in emergency medicine, and clinical probability assessment is a fundamental step in its diagnosis. Materials and Methods: All consecutive patients with suspicion of PE were enrolled in the study over a 1-year period. The diagnosis of PE was confirmed by multidetector computed tomography (MDCT) angiography. Patients underwent detailed clinical history, examination, chest X-ray, D-dimer testing, and echocardiography. Well’s and Revised Geneva scores were calculated for all patients. The sensitivity, specificity, predictive value positive, predictive value negative, positive and negative likelihood ratios were calculated for these prediction scores using CT results as the gold standard. Results: On MDCT pulmonary angiography, 64 patients (59.8%) were found to have PE, of which 36 (56.2%) were men, and 28 (43.8%) were women. Well’s Score >4, i.e., PE likely was documented in 59.4% of patients, and Revised Geneva Score ≥11, i.e., high probability of PE was documented in 21.9% of patients. The most sensitive parameter for the diagnosis of PE was the Revised Geneva Score (>4 score) (sensitivity 100%), whereas the Revised Geneva Score ≥11 was the most specific (93% specificity) parameter, followed by the combination of positive D-dimer test and Well’s Score >4 (79.1%). The diagnostic accuracy of Well’s Score >4 (64.5%) was higher than that of the Revised Geneva Score ≥11 (50.5%). Conclusion: Positive D-dimer has the best diagnostic accuracy for the diagnosis of PE. Well’s score has better diagnostic accuracy than the revised Geneva score, especially when combined with positive D-dimer.
A BSTRACT Background: Atherosclerosis is a systemic inflammatory disease in which hematological indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, red cell distribution width, and mean platelet volume have emerged as inexpensive markers of inflammatory activity. Their relationship with angiographic severity of coronary artery disease (CAD) and short-term outcomes remains incompletely characterized, particularly in Indian populations. Materials and Methods: This prospective, observational study enrolled 396 consecutive patients undergoing coronary angiography at a tertiary care center in North India. Preprocedural hematological profiles were obtained in all patients. Angiographic severity was assessed by vessel involvement and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score. Short-term in-hospital outcomes including acute kidney injury (AKI), left ventricular failure, and procedural complications were recorded. Statistical analyses included Kruskal–Wallis, Mann–Whitney U , and Spearman correlation analyses for nonnormally distributed variables. Results: The mean age was 54.6 ± 10.4 years and 79.5% of patients were male. ST-elevation myocardial infarction (STEMI) was the most common diagnosis (28.0%), while three-vessel disease predominated (47.5%). NLR demonstrated a stepwise numerical increase from single-vessel to three-vessel disease, although this did not achieve statistical significance ( P = 0.244). NLR varied significantly across diagnostic categories ( P = 0.007), with highest values observed in non-STEMI. Patients developing AKI had significantly higher NLR values ( P = 0.043). However, none of the hematological indices correlated significantly with SYNTAX score. Conclusion: Hematological indices did not demonstrate significant association with angiographic complexity or SYNTAX score. Although NLR varied across clinical presentations and showed an unadjusted association with AKI, these findings should be interpreted cautiously pending validation in larger multicenter studies with multivariable adjustment.
A BSTRACT Sodium-glucose cotransporter-2 (SGLT2) inhibitors are widely used in the management of type 2 diabetes mellitus, especially in patients with cardiovascular comorbidities. However, they are associated with a rare but serious complication of euglycemic diabetic ketoacidosis, particularly delay/after physiologically stressful events like percutaneous coronary intervention. Early recognition through ketone monitoring and blood gas analysis is vital. Increased awareness, especially in the context of SGLT2 inhibitor use, will allow for timely diagnosis and improved patient outcomes.
A BSTRACT Background: Plaque rupture and plaque erosion are the key mechanisms underlying acute coronary syndromes. Optical coherence tomography (OCT) enables high-resolution in vivo assessment of culprit plaque morphology and has improved understanding of culprit plaque morphology. However, data on OCT-defined plaque characteristics in South Asian ST-segment elevation myocardial infarction (STEMI) populations remain limited. Objectives: The objective of this study is to compare the clinical and angiographic characteristics of STEMI patients with OCT-defined plaque erosion and plaque rupture. Materials and Methods: This cross-sectional study included 30 consecutive STEMI patients undergoing primary percutaneous coronary intervention with preintervention OCT imaging of the culprit lesion. Lesions were classified as plaque erosion or plaque rupture using the established OCT criteria. Demographic characteristics, cardiovascular risk factors, medication history, and angiographic variables were recorded and analyzed. Results: Plaque erosion was identified in 16 patients (53.3%) and plaque rupture in 14 patients (46.7%). Patients with plaque erosion tended to be younger and were more frequently smokers than those with plaque rupture. Prior statin use was numerically higher in the erosion group. The left anterior descending artery was the most common culprit vessel in both groups, followed by the right coronary artery and the left circumflex artery. OCT differentiated intact fibrous-cap lesions with overlying thrombus consistent with erosion from lesions showing fibrous-cap discontinuity and cavity formation consistent with rupture. Conclusion: OCT-defined plaque erosion and plaque rupture showed differing clinical profiles, with erosion more common among younger smokers. OCT provided additional mechanistic insight beyond angiography. Larger prospective studies are required to validate these findings and clarify their prognostic implications.
Background: The Friedewald equation, developed over 50 years ago from a small fasting North American cohort, remains the dominant low-density lipoprotein-cholesterol (LDL-C) estimator worldwide. Its validity in Indian patients – who exhibit distinctly elevated triglycerides (TG), lower high-density lipoprotein cholesterol, and high metabolic syndrome burden – has not been rigorously evaluated at scale. Objective: To subject all 26 available LDL-C estimation equations to head-to-head evaluation against a validated enzymatic direct assay across the full triglyceride spectrum in Indian laboratory practice. Materials and Methods: Retrospective cross-sectional analysis of 17,379 patients at a tertiary care referral hospital (October 2023– December 2024). Direct LDL-C was measured by the Beckman Coulter selective protection enzymatic assay. All 26 equations were evaluated for clinical concordance, mean bias, standard deviation of differences, and R2, stratified by LDL-C category and triglyceride stratum. Results: Among 1269 fasting patients with TG <400 mg/dL, Sampson-NIH showed the closest agreement with direct LDL-C measurement (r = 0.948, R2 = 0.899, mean bias = 2.17 mg/dL, mean absolute error = 4.63 mg/dL), followed by Jeong et al. (r = 0.942, R2 = 0.888). Friedewald’s formula had the weakest agreement (R2 = 0.813, concordance 51.9%), with a substantial systematic mean bias of − 178 mg/dL at TG ≥1000 mg/dL. Agreement with direct LDL-C deteriorated progressively above TG 400 mg/dL (R2 < 0.25 for all equations). Conclusions: Sampson-NIH and Jeong are meaningfully superior to Friedewald’s in Indian patients, particularly at TG >200 mg/dL and low LDL-C values. Direct LDL-C measurement is essential when TG exceeds 400 mg/dL.
Aim: Recently, the youth (defined here as 20–30 years old) have been adopting new lifestyle choices and habits that can influence their risk of cardiovascular diseases (CVD) such as arrhythmia and coronary heart diseases. Research on CVD in youth is relatively scarce due to the low prevalence of CVD among youth and nonavailability of reliable large-scale health data on the youth. This study is an attempt to analyze whether controllable factors influence CVD risk among youth. We hypothesized that physical attributes, dietary behavior, and physical activity play key roles in mitigating the risk of CVD in youth. Materials and Methods: The data used for this study were the National Health and Nutrition Examination Survey (NHANES) data. Data used in this study were obtained from 6 biennial cycles from 2008 to 2020 of the United States of America (USA) NHANES, which had a sample size of 4700–5800 per cycle representing a USA youth population of 34–42 million per cycle. The cycles were combined using the guidelines and sample weights provided by NHANES. Physical attributes, diet and physical activity behavior data were taken from various demographics and questionnaire data of NHANES. Results: Analysis suggested that the CVD risk score for USA youth, based on the 30-year Framingham risk score (FRS), is low. However, statistical tests indicated that physical attributes, dietary behavior, and physical activity do influence CVD risk among youth. Specifically, high body mass index (BMI), obesity, alcohol consumption, eating out frequently, and consuming fast food were associated with higher CVD risk. Youth who had an excellent diet, adequate sleep, and who engaged in vigorous recreational activities, such as playing basketball, walking, and bicycling, had lower CVD risk. Importantly, the analysis indicated that having an excellent diet outweighed the impact of moderate or vigorous physical activity in reducing the CVD risk. Conclusion: The CVD risk score for USA youth, based on the 30-year FRS, is low. However, physical attributes, dietary behavior, and physical activity influence CVD risk among youth. Youth with excellent diets had lower FRS scores.
Orthostatic hypotension (OH) refers to a clinically significant decline in blood pressure upon standing. Mirtazapine, a tetracyclic antidepressant, has been typically associated with sedation and weight gain; however, cases of OH were rarely reported, predominantly in elderly patients at higher doses. This case reported a unique presentation of OH at a therapeutic dose (15 mg/day) in a young patient (body mass index: 22.4 kg/m²) without conventional risk factors – a combination not previously documented in the literature. A 40-year-old female with major depressive disorder presented with generalized weakness, dizziness, and lightheadedness after initiating mirtazapine. Clinical evaluation revealed significant hypotension (supine 122/78 mmHg to standing 88/52 mm Hg and heart rate: 72–96 bpm) without other identifiable causes. The Naranjo Adverse Drug Reaction Probability Scale yielded a score of 7, indicating a probable adverse drug reaction. Complete discontinuation of mirtazapine resulted in resolution of symptoms within 72 h, with blood pressure returning to baseline values. These findings underscored the need for clinicians to remain vigilant about potential OH even at standard doses of mirtazapine in patients without typical risk factors.
Bartter syndrome is a rare autosomal recessive disorder involving the renal tubules, resulting in defective salt reabsorption and renal salt wasting. There are five types of Bartter syndrome, which affect different parts of the renal tubules. Most cases of Bartter syndrome present early in infancy with polyuria and dehydration or antenatally with gross polyhydramnios. Type 3 Bartter syndrome, also known as Classic Bartter syndrome, however, can present in the first and second decades of life with symptoms related to the severe hypokalemia, including arrythmias, recurrent vomitings, fatigue, weakness, and rarely cardiomyopathy. We describe one such case of Type 3 Bartter syndrome who presented in early adulthood with palpitations and arrythmias due to severe hypokalemia.
Aim: This evaluative study aimed to assess the effectiveness of a comprehensive cardiopulmonary resuscitation (CPR) training program for intensive care unit (ICU) nurses and its impact on real-time CPR performance and patient outcomes. Materials and Methods: In Phase 1, 89 ICU nurses underwent a 2.5-day basic life support and advanced life support training program, and their knowledge and skills were assessed pre- and postintervention using validated tools. Phase 2 involved a 6-month prospective observational study of 33 trained nurses to evaluate real-time CPR performance during 28 cardiac arrest events in the ICU. Results: Significant improvements were observed in the nurses’ knowledge (10.16 ± 0.38 vs. 16.69 ± 0.25, P < 0.001) and practical skills (11.21 ± 10.47 vs. 52.39 ± 5.7, P < 0.001) following the training program. Real-time assessment demonstrated high-quality CPR components, including adequate compression rates (99.48 ± 9.8/min) and minimal delays to CPR initiation (72.68 ± 33.18 s). Despite these improvements, patient outcomes remained poor, with a mortality rate of 78.6% (22/28) despite attempted resuscitation. Only six patients achieved return of spontaneous circulation, with three surviving at 6 h. Conclusion: This study highlights the effectiveness of targeted CPR training in improving nurses’ skills but underscores the ongoing challenges in translating these improvements into better patient outcomes. Continuous quality improvement initiatives and a multifaceted approach to in-hospital cardiac arrest management are necessary to enhance ICU survival rates.
Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital cardiac anomaly, representing <1% of all congenital heart defects. It is defined by atrioventricular and ventriculoarterial discordance and is frequently associated with additional structural abnormalities such as ventricular septal defect, pulmonary outflow tract obstruction, or systemic atrioventricular (tricuspid) valve disease. The clinical course is highly variable; whereas some patients remain asymptomatic and undiagnosed until adulthood, systemic right ventricular (RV), dysfunction and conduction disturbances are common late complications. We present the case of a 56-year-old male who had previously undergone permanent pacemaker implantation for complete heart block at the age of 45 years, and later presented with congestive heart failure. This case underscores the importance of early recognition of CCTGA in adults, where meticulous echocardiographic evaluation and timely management play a crucial role in improving long-term outcomes.
Fasting before invasive procedures is a long-standing surgical practice, but its necessity for cardiac interventions under conscious sedation is unclear. To clarify this, we performed a meta-analysis of randomized controlled trials comparing fasting and nonfasting protocols in patients undergoing cardiac interventions. Our international prospective register of systematic reviews (PROSPERO) registered study (CRD-42024616824) systematically reviewed literature up to April 2025, ultimately including seven trials with 2532 patients. We found nonfasting status didn’t show any differences for hypoglycemia (OR: 0.63, CI: 0.23–1.74), periprocedural nausea/vomiting (OR: 0.94, CI: 0.48–1.87), short-term mortality (OR: 0.75, CI: 0.16–3.40) and respiratory infections (OR: 0.49, CI: 0.10–2.34). Our meta-analysis challenged the traditional practice of prolonged fasting before cardiac interventions, revealing no higher odds of adverse events, including nausea, vomiting, short-term mortality, and pneumonia in a nonfasting state before the cardiac interventions.
Context: Accurate blood pressure (BP) measurement is fundamental for hypertension diagnosis and management, yet guideline-recommended practices are inconsistently implemented. Aims: This study aimed to assess the practices, availability, and barriers related to appropriate BP cuff selection among physicians in India. Settings and Design: A cross-sectional e-survey was conducted among 7251 physicians practicing across India from June 2025 to September 2025. Subjects and Methods: Data were collected on cuff availability, measurement techniques, and procedural barriers using an electronic questionnaire. Statistical Analysis Used: This study was designed as a descriptive analysis. Data were summarized using descriptive statistics and presented as frequencies and percentages for categorical variables. No inferential statistical tests were performed. Results: While 65% of physicians reported routinely measuring arm circumference, only 48% had access to multiple cuff sizes. A strong association was observed between cuff availability and measurement practices: 93% of physicians with multiple cuffs measured arm circumference versus 39% without adequate cuff availability. Medium cuffs were predominantly used (63%), with availability significantly influencing cuff selection. Critical gaps were identified: 64% used incorrect cuff sizes when proper sizes were unavailable, 36% reported inability to procure needed cuffs, and only 33% consistently ensured direct skin contact during measurement. Conclusions: This study reveals a significant equipment-practice gap in BP measurement, characterized by inadequate cuff availability leading to compromised measurement techniques and failures in accurate BP measurements. These findings highlight the urgent need for systemic interventions to ensure adequate resource allocation and reinforce standardized practices to improve hypertension management accuracy.
