RESUMEN
Background: Heart failure is a major public health problem with rising prevalence and accounts for a substantial number of OPD and emergency visits. Despite advances in pharmacotherapy and various devices being added to the armamentarium in managing heart failure the mortality continue to remain high. Therefore, we seek to find an easy bedside tool for risk stratification and prognostication of patients suffering from chronic heart failure for identifying patients with high risk and tailoring appropriate therapy for better outcome. Methods: Consecutive patients, clinically diagnosed as heart failure supported by objective evidence of cardiac dysfunction: either a LVEF 45% or LA dilatation, or both was studied to find out the etiologies, symptoms and signs, derangement of laboratory parameters and echocardiographic findings including IVC diameter and was followed up for six months at monthly intervals. Results: A prospective observational study was performed on 62 patients. Majority of heart failure occurred in the age group of 51 to 60 years. Acute coronary events, infections, arrhythmias were the commonest precipitating factors. An increase in LVIDD, LA diameter, LA volume index was significantly associated with increase in mortality (p=0.002, p=0.034, p=0.011 respectively. An increase in IVC diameter was found to be significantly associated with increased mortality (P=0.001). Conclusion: In a country with limited resources like India, inferior vena caval diameter, as a surrogate marker of congestion, may prove to be a cost effective way in predicting and prognosticating patients with heart failure.
Asunto(s)
Insuficiencia Cardíaca/diagnóstico , Vena Cava Inferior/anatomía & histología , Humanos , India , Persona de Mediana Edad , Pronóstico , Estudios ProspectivosRESUMEN
The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia, which is very difficult to treat. Significant beneficial effects have been found for amitriptyline, gabapentin, pregabalin, carbamazepine, sodium valproate, oxycodone, corticosteroid, topical capsaicin, tramadol, etc. The aim of this open randomized comparative study was to demonstrate clinical efficacy of amitriptyline and pregabalin. The study included 50 patients, 32 (64%) male and 18 (36%) female, randomized to receive either amitriptyline or pregabalin (n=25 each). Amitriptyline was administered in a dose of 25 mg once daily and pregabalin in a dose of 75 mg twice daily. Inclusion criteria were as follows: postherpetic neuralgia of more than 1 month duration; pain of at least moderate severity; and patient age 40 years or older and no pregnancy. Patients with a history of any serious diseases (renal, cardiac, hepatic or seizure) were excluded. Total treatment period spanned 8 weeks, with patient follow up visits at 2, 4 and 8 weeks to assess the degree of improvement in pain perception and any adverse reaction. Patients with four herpes zoster types were included in this study, of which thoracic type predominated (54%). Other types were cervical in 12 (24%), trigeminal in 8 (16%) and lumbosacral in 3 (6%) patients. Prodromal symptoms before herpes zoster were reported by 66% of study patients. Satisfactory improvements of pain perception at the end of 8 weeks (>75%) were noticed in pregabalin group, which was statistically significant (χ(2)2=10.08; P<0.05). Dry mouth was the commonest complication in amitriptyline group and dizziness in pregabalin group. More importantly, none of the patients stopped treatment due to adverse reaction. In conclusion, therapy with pregabalin is better compared to amitriptyline in postherpetic neuralgia patients. However, a similar study in a larger sample is required to validate the present findings.