Frontier Lifeline Hospital

Abstract Background: Worsening heart failure (WHF) is characterized by the progression of symptoms in patients with established HF, necessitating intensified treatment, typically with diuretics. Outpatient (OP) management of WHF offers an alternative to hospitalization, as many patients experience a gradual onset of symptoms, allowing timely intervention. However, OP WHF is often underrecognized and excluded from clinical trials, highlighting the need for structured guidance. This expert consensus aims to address this gap by providing clinical practice recommendations for OP WHF management. Methodology: A panel of Indian cardiologists convened for an expert meeting moderated by a leading cardiologist. Based on clinical evidence, expert insights, and live polling, consensus recommendations were developed. Results: Experts agreed that WHF is defined by symptom worsening despite standard HF therapy, decompensation in chronic HF, and an increase in oral or intravenous diuretic dose. Vericiguat was recognized as suitable for patients with reduced eGFR (<30 mL/min/1.73 m²), unlike angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNi) and digoxin. While ACEi/ARB/ARNi doses may be reduced in WHF with worsening renal function, beta-blockers should be maintained as long as possible. OP management should prioritize early vericiguat initiation alongside rapid HF therapy optimization. About 44% of experts recommended initiating vericiguat at the first follow-up (3–7 days postdischarge), whereas 33.3% preferred it as a last-line option. Management of end-stage heart failure with advanced options like assist devices and transplants is needed with failure of drug therapy, persisting end-organ failure, and repeated hospitalization. Conclusion: This consensus highlights early OP department (OPD)-based recognition of WHF, OPD-based structured HF therapy optimization, and early vericiguat initiation to improve WHF management in outpatient settings.

Background: We aimed to understand the current practices of Indian practitioners in the management of hypertensive patients with ischemic heart disease. Methods: A quantitative, cross-sectional, questionnaire-based survey involving 145 cardiologists and consulting physicians who each saw 10 patients with hypertension and IHD in their clinical practice was conducted. The questionnaire consisted of 35 questions divided into three sections on prevalence and treatment of hypertension and IHD and role of fixed-dose combinations in therapy. Results: In all, 49.0% of physicians treated 25%-50% patients with hypertension and IHD in their routine practice, majority of whom were in the age group of 40-60 years regardless of gender. Telmisartan (97.0%) and metoprolol (86.0%) were the most preferred angiotensin receptor blocker (ARB) and beta-blocker, respectively, and 91.0% of physicians preferred a combination of metoprolol with telmisartan when monotherapy fails. In the opinion of the physicians, prevention of new cardiovascular events (63.0%) and improvement in quality of life (61.0%) were the leading benefits of telmisartan and metoprolol FDC, and all agreed that this FDC improves patient compliance and adherence to therapy. Furthermore, 97.0%, 90.0%, and 40.0% of physicians agreed/strongly agreed that the FDC could be prescribed to hypertensive patients with IHD, heart failure, and IHD and diabetes, respectively. Conclusions: In this pan-India survey, it was observed that FDCs of telmisartan and metoprolol could help in improving blood pressure, heart rate, patient compliance, and adherence to therapy. Nevertheless, large-scale, prospectively designed studies are warranted to validate these findings.

BackgroundABO blood group types are hereditary factors that have been shown to affect the blood levels of many antigens and proteins. Some blood groups have surprisingly been shown to be associated with some specific diseases, probably due to yet unexplained altering effects on the immune system or on the levels of other system-specific proteins. Studies conducted previously attempting to relate bronchial asthma and blood groups have had variable results and such studies on a large scale have not been ventured in India. Hence, the significance of the current study, which aims to search for an increased occurrence of bronchial asthma in any one of the ABO blood group phenotypes and additionally in Rh blood groups.ObjectiveThe objective of this study was to analyze the possible association of the ABO and Rh blood group types with bronchial asthma. MethodsThis is an observational study with 475 bronchial asthma patients, and 2052 non-asthmatic individuals belonging to the same geographical zone. After obtaining informed consent, ABO and Rh Blood group testing was done on the study subjects using the hemagglutination method. Chi-squared tests were employed for the comparison of proportions. Statistical significance was agreed upon for an error of 5%.ResultsThe O blood group was predominant in both cases (46.9 %) and controls (36.1%). A chi-square analysis revealed a statistically significant higher percentage of O blood group in patients (χ2: 24.537; degrees of freedom (DF): 3; p-value = <0.01). The cases had more Rh -ve individuals (12%) than controls (8%), which too was statistically significant (χ2: 6.711; degrees of freedom (DF): 1; p-value = 0.01).ConclusionThe present study shows a positive association between the O blood group and the Rh-negative blood group with bronchial asthma.

ObjectiveMany low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies.DesignRetrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment. Spearman correlation coefficients were calculated.Setting and participantsThe International Quality Improvement Collaborative (IQIC) keeps a volunteer registry of outcomes of CHD surgery programmes in low-resource settings. Inclusion in the IQIC is voluntary enrolment by hospital sites. Patients in the registry underwent congenital heart surgery. Sites that actively participated in IQIC in 2013, 2014 or 2015 and passed a 10% data audit were asked for permission to share data for this study. 31 sites in 17 countries are included.Outcome measuresIn-hospital mortality: standardised mortality ratios were calculated. Risk adjustment for in-hospital mortality uses the Risk Adjustment for Congenital Heart Surgery method, a model including surgical risk category, age group, prematurity, presence of a major non-cardiac structural anomaly and multiple congenital heart procedures during admission.ResultsThe IQIC registry includes 24 917 congenital heart surgeries performed in children<18 years of age. The overall in-hospital mortality rate was 5.0%. Country-level congenital heart surgery standardised mortality ratios were negatively correlated with gross domestic product (GDP) per capita (r=−0.34, p=0.18), and health expenditure per capita (r=−0.23, p=0.37) and positively correlated with under-five mortality (r=0.60, p=0.01) and undernourishment (r=0.39, p=0.17). Countries with lower development had wider variation in mortality. GDP per capita is a driver of the association between some other measures and mortality.ConclusionsResults display a moderate relationship among wealth, healthcare investment and malnutrition, with significant variation, including superior results in many countries with low GDP per capita. These findings provide context and optimism for investment in CHD procedures in low-resource settings.

Poly-L-lactic acid (PLLA) is a biodegradable synthetic polyester synthesized by polymerization or polycondensation. PLLA hydrolytically degrades into lactic acid, a biocompatible metabolic by-product, making it suitable for clinical applications. PLLA scaffolds or nanofibers have been used in various regenerative medicine and drug delivery applications. These scaffolds impart biocompatible properties of high surface area, hydrophobicity, native extracellular properties, and mechanical strength for an organ system. Moreover, PLLA nanofibers hold great promise as drug delivery systems, where fabrication parameters and drug-PLA compatibility greatly affect the drug release kinetics. In this chapter, we present the protocols to fabricate, electrospinning, and validation of 3D PLLA nanofibrous scaffolds for tissue engineering application and offer perspectives on their future use.

This study aims to unravel the use of GSK-3 inhibitors as viable apoptotic inducers for teratocarcinoma-derived ovarian PA-1 cells. MTT assay was carried out to assess inhibitory concentrations of LiCl and TDG. AO/EB staining and Hoechst 33258 staining were employed to assess the damage. Mitochondrial membrane potential (ΔΨm) and ROS generation were assessed with IC50 concentrations of LiCl and TDG. Tumor-related genes (p53, p21, IL-8, TNF-α, MMP-2, Fas-L, Cox-2, and caspase-3) were assessed with 1/4 IC50, 1/2 IC50, IC50 concentrations by semi-quantitative RT- PCR. Cell cycle analysis was performed with IC50 concentration of LiCl and TDG. Western blot analysis was performed for caspase-3, caspase-7, caspase-9, PARP to estimate the possible damage induced by GSK-3 inhibitors and regulation of GSK-3β, pGSK-3β, Cox-2. GSK-3 inhibitors demonstrated a concentration and time-dependent reduction in cell viability, exhibiting significant ROS generation and reduced ΔΨm at their IC50 values. Substantial concentration-dependent gene expression changes with significant upregulation of P21, Cox-2, TNF-α, caspase-3, Fas-L were observed. Protein expression of caspase-3 caspase-7, caspase-9, PARP exhibited significant cleavage in LiCl and TDG-treated cells. Protein expression of Cox-2 was significantly increased in IC50 concentration of TDG. Cell cycle analysis showed significant accumulation of cells at sub-G0-G1.