Lourdes Hospital

Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.

Abstract Background Neutralizing antibody is reported to correlate with protection from symptomatic chikungunya disease. In addition to direct virus neutralization, virus-specific antibodies can also protect through antibody effector functions via antibody-dependent cellular cytotoxicity (ADCC) mechanism. Methods We have assessed NK cell-mediated chikungunya virus (CHIKV) specific ADCC response in 56 acute, 56 prolonged, 44 chronic chikungunya arthritis patients, 23 recovered individuals from chikungunya (CHIK) & 50 healthy controls using a flow cytometry-based antibody-dependent heterologous NK cell activation assay with ADCC surrogate markers CD107a & IFN-γ. Results Persistent ADCC response in recovered individuals spanning over a duration of 3 months to 18 years post-infection and progressive decline in ADCC response in chronic chikungunya arthritis patients over the period of time were observed. ADCC response correlated with lower plasma viral load in acute patients ( p =0.022, r=-0.709). Recovered individuals elucidated a positive correlation between ADCC response and plasma anti-CHIKV IgG and IgG3 antibody levels (IgG: r=0.4503, IgG3: r=0.4583, p -value<0.01 in each). Conclusion Overall, the current study establishes the prognostic role of NK cells-mediated ADCC response in chikungunya infection. In a nutshell, these findings provide a base for future antibody-based therapeutics for chikungunya utilizing IgG3 antibody that has functional ADCC capacity. Graphical Abstract Highlights NK cells play key role in chikungunya infection NK cells mediated ADCC response remain unexplored in chikungunya Anti-CHIKV IgG3 antibody dependent activation of the NK cells observed Efficient NK cells mediated ADCC response detected in acute & recovery phases of chikungunya IgG3 with functional ADCC capacity can direct Ab-based therapeutics design in chikungunya

ObjectivesThis study aimed to analyse the number of myocardial infarction (MI) admissions during the COVID-19 lockdown periods of 2020 and 2021 (March 15th to June 15th) and compare them with corresponding pre-pandemic period in 2019. The study also evaluated changes in critical treatment intervals: onset to door (O2D), door to balloon (D2B) and door to needle (D2N) and assessed 30-day clinical outcomes. This study examined MI care trends in India during the COVID-19 lockdown period, irrespective of patients’ COVID-19 infection status.DesignMulticentre retrospective cohort studySettingTwenty-three public and private hospitals across multiple Indian states, all with 24/7 interventional cardiology facilities.ParticipantsAll adults (>18 years) admitted with acute myocardial infarction between March 15 and June 15 in 2019 (pre-pandemic), 2020 (first lockdown) and 2021 (second lockdown). A total of 3614 cases were analysed after excluding duplicates and incomplete data.Primary outcomesNumber of MI admissions, median O2D, D2B and D2N times.Secondary outcomes30-day outcomes including death, reinfarction and revascularisation.ResultsMI admissions dropped from 4470 in year 2019 to 2131 (2020) and 1483 (2021). The median O2D increased from 200 min (IQR 115–428) pre-COVID-19 to 390 min (IQR 165–796) in 2020 and 304 min (IQR 135–780) in 2021. The median D2B time reduced from 225 min (IQR 120–420) in 2019 to 100 min (IQR 53–510) in 2020 and 130 min (IQR 60–704) in 2021. Similarly, D2N time decreased from 240 min (IQR 120–840) to 35 min (IQR 25–69) and 45 min (IQR 24–75), respectively. The 30-day outcome of death, reinfarction and revascularisation was 4.25% in 2020 and 5.1% in 2021, comparable to 5.8% reported in the Acute Coronary Syndrome Quality Improvement in Kerala study.ConclusionDespite the expansion of catheterisation facilities across India, the country continues to fall short of achieving international benchmarks for optimal MI care.

Migraine is a common disorder characterized by recurrent, usually unilateral, pulsatile headaches often accompanied by nausea, vomiting, photophobia, phonophobia, and fatigue. Visual aura is the most common of all aura symptoms in migraine patients. The aura and headache phases of migraine are caused by intracranial vasoconstriction and extracranial vasodilation, respectively. Migrainous aura without infarction refers to migraine aura symptoms that persist for an extended period of one week or longer without any evidence of infarction on imaging. Arterial spin labelling (ASL) is a non-invasive magnetic resonance imagingtechnique used to quantitatively assess cerebral blood flow. It can be used to track perfusion changes over the migraine cycle. This case report highlights the utility of ASL as a non-invasive tool to detect reversible perfusion changes in persistent migrainous aura, aiding in differentiating it from ischemic events, offering insights into underlying pathophysiology, such as cortical spreading depression, and informing more accurate clinical management.

Abstract Background: Heart failure (HF) remains a leading global cause of morbidity, hospitalizations, and mortality. Although sacubitril/valsartan has shown superior clinical outcomes compared with conventional angiotensin II receptor blockers, its higher cost and potential side effects have limited its broader use. Telmisartan, a widely prescribed and cost-effective angiotensin receptor blocker, is known for its favorable safety profile. However, direct comparisons between sacubitril/valsartan and telmisartan are limited. This study was conducted to evaluate and compare the effectiveness, safety, and cost-effectiveness of sacubitril/valsartan versus telmisartan in patients with HF with reduced ejection fraction (EF; HFrEF) within a tertiary care hospital setting. Materials and Methods: A 6-month prospective study was carried out in the Department of Cardiology at a tertiary care hospital. Data on patient demographics, echocardiographic findings, incidence of adverse drug reactions (ADRs), and treatment-related costs were collected using a structured data collection form. Results: A total of 72 patients met the inclusion criteria—33 received sacubitril/valsartan and 39 received telmisartan. The primary outcome was the change in left ventricular (LV) EF (LVEF) from baseline to the end of a 3-month follow-up. Both groups showed significant improvements in LVEF; however, the sacubitril/valsartan group showed a greater increase (mean EF = 44%) than the telmisartan group (mean EF = 38%). Safety analysis indicated no statistically significant difference in ADR incidence between the two groups. Nevertheless, the total cost of therapy was considerably higher in the sacubitril/valsartan group than in the telmisartan group. Conclusion: Sacubitril/valsartan demonstrated greater efficacy in improving EF over 3 months compared with telmisartan in patients with HFrEF. Although it is associated with higher treatment costs, the enhanced clinical benefits and favorable outcomes support its use as a superior therapeutic option for managing HFrEF.

Describe the demographic and professional profiles of the family physicians. 1. To study the factors associated with practice patterns. It is a cross-sectional, questionnaire-based study. The questionnaire included demographic and professional profiles of the family physicians. 1. Doctors practising as family physicians, who do not hold a postgraduate degree in Family Medicine (those with MBBBS or post-MBBS fellowships or diplomas in FM through distance education) and 2. Doctors practising as family physicians, who hold an NMC-recognised postgraduate degree or diploma in Family Medicine (MD, DNB or DFM-NBEMS). Results and. The majority of family physicians in India are young, female doctors, concentrated more in the urban area, and the majority have an experience lesser than 15 years, reflecting the recent growth in the number of family physicians. 1. 59.66% of family physicians are engaged in community practice. Community practitioners are predominantly male. 70% practise the entire spectrum of general practice with 80% having a good referral system and 33.6% earning more than 1 lakh. 2. 40% of family physicians are engaged in hospital practice. Hospital practice doctors are predominantly females, 50% practise the entire spectrum of general practice, and 58.69% earn more than 1 lakh per month. 3. 56% of the family physicians have a master degree. Family physicians with a master degree are predominately female, 58% of them are into hospital practice, their practices are well equipped, 55.29% practise the entire spectrum, and 52.9% earn more than 1 lakh per month. 4. There is independent association of practice type with number of working hours, area of practice, in-patient services, and qualification. 5. There is independent association of qualification with gender, years of experience, area of practice, practice type, and income more than 1 lakh per month.