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Triple drug combination of telmisartan, amlodipine and hydrochlorothiazide in the treatment of essential hypertension

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Open Journal of Internal Medicine 2012年第2期2卷 67-71页

作者： Manish Maladkar Vijay Kumar Verma Keshav A. Narsikar Rajan D. Walinjkar W. R. Patil N. J. S. Saggu Suresh P. Kulkarni 8 Shalom Navi Mumbai India Agarwal Hospital Thane (West) India clinic 411 Jack Chambers Navi Mumbai India Head-Medical & Regulatory Affairs Aristo Pharmaceuticals Pvt Ltd Mumbai India JN-2/47/P2 Navi Mumbai India Shree Polyclinic 114 Nirman Vyapar Kendra Navi Mumbai India yash speciality clinic Nirman Vyapar Kendra Navi Mumbai India

Background: Triple drug therapy comprising angiotensin receptor blocker (ARB), calcium channel blocker (CCB) and hydrochlorothiazide (HCT) effectively controls essential hypertension as evident from the literature. This study was undertaken to assess the efficacy and safety of triple combination compared to the dual drug therapy. Methodologies: A total of 220 male and female patients with essential hypertension were enrolled in the study. The patients were divided into two groups. Group A received a bilayer tablet of FDC of Telmisartan + Amlodipine + HCT and group B received FDC tablet of Telmisartan + HCT. Both the treatments were administered once daily for twelve weeks. The patients were asked to follow-up on week 1, 2, 4, 6, 8 and 10 for periodic efficacy and safety evaluations. Effect on systolic blood pressure (SBP), diastolic blood pressure (DBP) and quality of life (QOL) were recorded during the course of the trial. Results: Blood pressure reduction (BP) to the desired goals was observed with both the treatments. The SBP and DBP reductions were superior in triple combination therapy than double combination. Both treatments improved QOL of patients. Conclusion: Triple drug combination of telmisartan, amlodipine and HCT may serve a potential role in achieving desired BP goals, in patients with essential hypertension, which are otherwise poorly managed by either monotherapy or dual drug therapy.

关键词： Essential Hypertension Telmisartan Amlodipine and HCT

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Healthcare utilization and costs associated with gastroparesis

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World Journal of Gastroenterology 2017年第24期23卷 4428-4436页

作者： Vaibhav Wadhwa Dhruv Mehta yash Jobanputra Rocio Lopez Prashanthi N Thota Madhusudhan R Sanaka Department of Internal Medicine Fairview HospitalCleveland Clinic Department of Internal Medicine Westchester Medical Center Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland Clinic Center for Advanced Endoscopy Digestive Disease InstituteCleveland Clinic

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSIONThe number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient cost

关键词： Inpatient admission rates Gastroparesis Cancer epidemiology National inpatient database

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Healthcare utilization and costs associated with cholangiocarcinoma

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Gastroenterology Report 2017年第3期5卷 213-218,I0002页

作者： Vaibhav Wadhwa yash Jobanputra Prashanthi N.Thota KVNarayanan Menon Mansour A.Parsi Madhusudhan R.Sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicClevelandOhio Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicOhio

Background and *** is a rare but devastating malignancy associated with a poor prognosis and a high mortality *** the recent advances in detection and treatment,it is unclear if the incidence and outcomes of cholangiocarcinoma are improving in the United *** aim of this study was to evaluate the trends in the incidence,costs and mortality rates of cholangiocarcinoma-related hospital admissions in the *** utilized the National Inpatient Sample Database(NIS)from 1997–2012 for all patients in whom cholangiocarcinoma(ICD-9 code 155.1,156)was the principal discharge *** temporal trends in the number of hospital admissions,length of stay and,hospitalization costs along with mortality rates over the study period were determined by using regression analysis for *** was a significant increase in the number of hospital admissions for cholangiocarcinoma as the principal diagnosis from 1997 to 2012(10357 vs 11970,P<0.001).The mean length of stay for cholangiocarcinoma decreased by 17%between 1997 and 2012 from 9.5 days to 7.9 days(P<0.001).However,during the same period,the mean hospital charges per patient(adjusted for inflation)increased 113.25% from $36460 in 1997 to$77753 in *** in-hospital mortality rate decreased from 9.3% in 1997 to 6.4% in 2012(P<0.001).*** was a significant increase in the number of hospital admissions and associated costs from cholangiocarcinoma in the USA between 1997 and ***,this was accompanied by a decrease in the inpatient mortality rates from cholangiocarcinoma.

关键词： cholangiocarcinoma inpatient admissions hospital charges in-hospital mortality epidemiology

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Vildagliptin vs sulfonylurea in Indian Muslim diabetes patients fasting during Ramadan

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World Journal of Diabetes 2013年第6期4卷 358-364页

作者： Abhijit Shete Aheson Shaikh K Javeed Nayeem Lily Rodrigues Mohamed Sheikamunadeen Sadiq Ali Parag Shah Rajiv Khanna Sarfaraj Majid Sabeer A Rasheed Shehla Shaikh Tawfiqur Rahman Medical Department Novartis Pharma AGCH-4002 BaselSwitzerland Diabetes Care Centre Bibi Ayesha Mili Hospital Suraksha Multi speciality Hospital Irfan Cardiac and Diabetic clinic Gujarat Endocrine Centre Khanna clinic Gole DarwazaRadhey lalChowkLucknow 226003India B P Poddar Hospital Dr.Rasheed’s Diabetes speciality Centre KGN Diabetes & Endocrinology Center GD Diabetic Institute

AIM:To compare the use of vildagliptin and sulfonylurea with or without metformin in Indian Muslim patients with type 2 diabetes mellitus,fasting during ***:This was a 4-wk,multicenter,non-interventional,open-label,observational *** of hypoglycemic events(HEs),adverse events,and changes in glycosylated hemoglobin A1c(HbA1c),fasting plasma glucose,postprandial plasma glucose and body weight were measured pre-and ***:Totally,97 patients were recruited and all completed the study(vildagliptin group,n=55;sulfonylurea group,n=42).HEs were reported in low frequencies in both the vildagliptin and the sulfonylurea groups[0 vs 2(4.8%)patients,respectively].Interestingly,HbA1c reduced by-0.43%(-4.71 mmol/mol)in the vildagliptin group[8.75%(72.10 mmol/mol)to8.32%(67.38 mmol/mol),P=0.009]while in the sulfonylurea group there was a small increase by 0.01%[0.08 mmol/mol;8.64%(70.92 mmol/mol)to 8.65%(71.00 mmol/mol),P=0.958].Higher percentage of vildagliptin-treated patients achieved HbA1c<7.0%(<53 mmol/mol)compared with sulfonylurea(16.4%vs4.8%).Mean decrease in the body weight was 1.2 kg and 0.03 kg,respectively(P<0.001).Both treatment groups were well tolerated during ***:Vildagliptin is an attractive treatment option for Indian patients with type 2 diabetes mellitus who are fasting during Ramadan.

关键词： Dipeptidyl-peptidase 4 inhibitors Fasting hypoglycemia Sulfonylurea Type 2 diabetes mellitus Vildagliptin

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Role of photon-counting computed tomography in pediatric cardiovascular imaging

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World Journal of clinical Pediatrics 2025年第1期14卷 55-62页

作者： Arosh S Perera Molligoda Arachchige yash Verma Faculty of Medicine Humanitas UniversityPieve Emanuele 20072Italy Department of Radiology Mayo ClinicRochesterMN 55905United States

Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular *** CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric *** direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced *** pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young *** spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart ***,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media *** clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular *** PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.

关键词： Cardiovascular Photon-counting detectors Pediatric Photon-counting computed tomography Computed tomography

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Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

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World Journal of Diabetes 2021年第10期12卷 1587-1621页

作者： Saptarshi Bhattacharya Sanjay Kalra Nitin Kapoor Rajiv Singla Deep Dutta Sameer Aggarwal Deepak Khandelwal Vineet Surana Atul Dhingra Viny Kantroo Sachin Chittawar Nilakshi Deka Vivek Bindal Puja Dutta Endocrinology Max Superspeciality HospitalNew Delhi 110092India Endocrinology Bharti HospitalKarnal 132001HaryanaIndia Endocrinology Christian Medical CollegeVellore 632004Tamil NaduIndia Endocrinology Kalpavriksh Super Speciality CenterNew Delhi 110075India Endocrinology CEDAR Superspecialty ClinicNew Delhi 110075India Endocrinology Apex Plus Superspeciality HospitalRohtak 124001HaryanaIndia Endocrinology Maharaja Agrasen HospitalNew Delhi 110026India Endocrinology Manipal HospitalsNew Delhi 110075India Endocrinology Gangaram Bansal Super Speciality HospitalSri Ganganagar 335001RajasthanIndia Respiratory Medicine&Critical Care Indraprastha Apollo HospitalsSarita ViharNew Delhi 110076India Endocrinology Gandhi Medical CollegeBhopal 462001Madhya PardeshIndia Endocrinology Apollo HospitalsGuwahati 781005AssamIndia Minimal Access Metabolic and Bariatric surgeryMax Superspeciality HospitalPatparganjNew Delhi 110092India Nutrition Max Superspeciality HospitalPatparganjNew Delhi 110092India

Diabetes mellitus(DM)and obesity are interrelated in a complex manner,and their coexistence predisposes patients to a plethora of medical *** surgery has evolved as a promising therapeutic option for both *** is recommended that patients,particularly those of Asian origin,maintain a lower body mass index threshold in the presence of uncontrolled ***,several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical *** Roux-en-Y gastric bypass(RYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used bariatric procedures *** bariatric benefits of RYGB and LSG are similar,but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM *** scoring systems have been formulated that are utilized to predict the chances of remission.A glycemic target of glycated hemoglobin<7%is a reasonable goal before ***,pulmonary,gastrointestinal,hepatic,renal,endocrine,nutritional,and psychological optimization of surgical candidates improves perioperative and long-term *** guidelines for preoperative care of individuals with obesity have been formulated,but very few specifically focus on the concerns arising from the presence of concomitant *** is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

关键词： Diabetes Obesity Metabolic surgery Bariatric surgery Remission of diabetes

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Nationwide trends of hospital admissions for acute cholecystitis in the United States

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Gastroenterology Report 2017年第1期5卷 36-42,I0002页

作者： Vaibhav Wadhwa yash Jobanputra Sushil K Garg Soumil Patwardhan Dhruv Mehta Madhusudhan R.Sanaka Department of Internal Medicine Fairview HospitalCleveland ClinicOHUSA Department of Gastroenterology and Hepatology Digestive Disease InstituteCleveland ClinicClevelandOHUSA Department of Internal Medicine University of MinnesotaMinneapolisMNUSA Department of Internal Medicine University of MassachusettsWorcesterMAUSA Department of Internal Medicine Westchester Medical CenterValhallaNYUSA

Background and aims:Acute cholecystitis is a fairly common inpatient diagnosis among the gastrointestinal *** aim of this study was to use a national database of US hospitals to evaluate the incidence and costs of hospital admissions associated with acute ***:We analyzed the National Inpatient Sample Database(NIS)for all patients in which acute cholecystitis(ICD-9 codes:574.00,574.01,574.30,574.31,574.60,574.61 or 575.0)was the principal discharge diagnosis from 1997 to *** NIS is the largest all-payer inpatient database in the United States and contains data from approximately 8 million hospital stays each *** statistical significance of the difference in the number of hospital discharges,lengths of stay and associated hospital costs over the study period was determined by using the Chi-square test for ***:In 1997,there were 149661 hospital admissions with a principal discharge diagnosis of acute cholecystitis,which increased to 215995 in 2012(P<0.001).The mean length of stay for acute cholecystitis decreased by 17% between 1997 and 2012(*** 4.7 days to 3.9 days);(P<0.05).During the same time period,however,mean hospital charges have increased by 195.4% from US$14608 per patient in 1997 to US$43152 per patient in 2012(P<0.001).Conclusion:The number of inpatient discharges related to acute cholecystitis has increased significantly in the United States over the last 16 years,along with a great increase in the associated hospital ***,there has been a gradual decline in the mean length of *** costs associated with acute cholecystitis contribute significantly to the total healthcare *** research on cost-effective evaluation and management of acute cholecystitis is required.

关键词： inpatient admission rates acute cholecystitis epidemiology trends

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TCM Child Massage and its clinical Relevance

TCM Child Massage and its Clinical Relevance

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Academic Conference of the Tenth Anniversary of World Federation of Acupuncture-Moxibustion

作者： Angela Rudhart Dyczynski Jeny Dyczynski clinic am Brunnenberg Special clinic for Cardiological and Orthopedical Rehabilitation Enderstrasse 508645 Bad ElsterSaxonyGermany clinic am Brunnenberg Special clinic for Cardiological and Orthopedical Rehabilitation Enderstrasse 508645 Bad ElsterSaxonyGermany

＜正＞Massage manipulation-known as An （"pressing"）, Mo （"rotating"）, Tui （"pushing"）, Na （"lifting"） is one of the key components of Traditional Chinese Medicine （TCM） therapeutic system. Child-massage, the soft massage for children, is an important sub-speciality of An Mo Tui Na and, a great treasure of Traditional Chinese Medicine. Like other TCM therapies, soft child massage is based

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Gastroenterology training in Latin America

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World Journal of Gastroenterology 2011年第18期17卷 2283-2287页

作者： Henry Cohen Roque Saenz Luiz E de Almeida Troncon Maribel Lizarzabal Carolina Olano Gastroenterology clinic Montevideo Medical School University del Desarrollo University of So Paulo Ribeiro Preto. Rua Bernardino Campos Rua Bernardino Campos 1000 Ribeirao Preto SP 14015-130 Brazil University del Zulia

Latin America is characterized by ethnic, geographical, cultural, and economic diversity; therefore, training in gastroenterology in the region must be considered in this context. The continent’s medical education is characterized by a lack of standards and the volume of research continues to be relatively small. There is a multiplicity of events in general gastroenterology and in sub-disciplines, both at regional and local levels, which ensure that many colleagues have access to information. Medical education programs must be based on a clinical vision and be considered in close contact with the patients. The programs should be properly supervised, appropriately defined, and evaluated on a regular basis. The disparity between the patients’ needs, the scarce resources available, and the pressures exerted by the health systems on doctors are frequent cited by those complaining of poor professionalism. Teaching development can play a critical role in ensuring the quality of teaching and learning in universities. Continuing professional development programs activities must be planned on the basis of the doctors’ needs, with clearly defined objectives and using proper learning methodologies designed for adults. They must be evaluated and accredited by a competent body, so that they may become the basis of a professional regulatory system. The specialty has made progress in the last decades, offering doctors various possibilities for professional development. The world gastroenterology organization has contributed to the speciality through three distinctive, but closely inter-related, programs: Training Centers, Train-the-Trainers, and Global Guidelines, in which Latin America is deeply involved.

关键词： Training Gastroenterology Latin America

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Critical care practice in India:Results of the intensive care unit need assessment survey(ININ2018)

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World Journal of Critical Care Medicine 2020年第2期9卷 31-42页

作者： Rahul Kashyap Kirtivardhan Vashistha Chetan Saini Taru Dutt Dileep Raman Vikas Bansal Harpreet Singh Geeta Bhandari Nagarajan Ramakrishnan Harshit Seth Divya Sharma Premkumar Seshadri Mradul Kumar Daga Mohan Gurjar yash Javeri Salim Surani Joseph Varon 无 Department of Anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Department of Infectious Disease Mayo ClinicRochesterMN 55905United States Department of Internal Medicine Allegheny General HospitalPittsburghPA 15212United States Department of Radiology Mayo ClinicRochesterMN 55905United States Department of Medicine Jacobi Medical Center/Albert Einstein College of MedicineBronxNY 14061United States Department of Neurology Mayo ClinicRochesterMN 55905United States and Department of PsychiatryHennepin County Medical CenterMinneapolisMN 55415United States Department of Medicine Cloud Physician HealthcareBangalore 560038India Department of Critical Care Medicine Mayo ClinicRochesterMN 55905United States Department of Internal Medicine Maulana Azad Medical College&Associated HospitalsNew DelhiDelhi 110002India Department of Anesthesiology Government Medical CollegeHaldwaniNainital 263129India Department of Critical Care Medicine Apollo HospitalsChennai 600006India Department of Hospitalist Medicine Allegany ClinicAllegany Health NetworkPittsburghPA 15222United States Premkumar Seshadri Department of MedicineMAAGF HealthcareChennai 600024India Department of Internal Medicine and Center for Occupational and Environment Health Maulana Azad Medical CollegeNew DelhiDelhi 110002India Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014India Department of Critical Care Medicine Regency Super Speciality HospitalLucknow 208005India Nayati Healthcare New DelhiDelhi 110065India Department of Pulmonary and Critical Care Medicine Texas A&M UniversityCollege StationTX 77843United States Department of Critical Care United Memorial Medical CenterHoustonTX 77091United States ININ-2018 Investigators Team

BACKGROUND A diverse country like India may have variable intensive care units(ICUs)practices at state and city *** To gain insight into clinical services and processes of care in ICUs in India,this would help plan for potential educational and quality improvement *** The Indian ICU needs assessment research group of diverse-skilled individuals was formed.A pan-India survey"Indian National ICU Needs"assessment(ININ 2018-I)was designed on google forms and deployed from July 23rd-August 25th,*** survey was sent to select distribution lists of ICU providers from all 29 states and 7 union territories(UTs).In addition to emails and phone calls,social medial applications-WhatsApp™,Facebook™and LinkedIn™were used to remind and motivate *** completing and submitting the survey,providers gave their consent for research *** study was deemed eligible for category-2 Institutional Review Board exempt *** There were total 134 adult/adult-pediatrics ICU responses from 24(83%out of 29)states,and two(28%out of 7)UTs in 61 *** had median(IQR)16(10-25)beds and most,were mixed medical-surgical,111(83%),with 108(81%)being adult-only *** responders were young,median(IQR),38(32-44)years age and majority,n=108(81%)were *** consultants were,n=101(75%).A total of 77(57%)reported to have 24 h in-house intensivist.A total of 68(51%)ICUs reported to have either 2:1 or 2≥:1 patient:nurse *** than 80%of the ICUs were open,and mixed *** followed regularly by the ICUs included sepsis care,ventilator-associated pneumonia(83%each);nutrition(82%),deep vein thrombosis prophylaxis(87%),stress ulcer prophylaxis(88%)and glycemic control(92%).Digital infrastructure was found to be poor,with only 46%of the ICUs reporting high-speed internet *** In this large,national,semi-structured,need-assessment survey,the need for improved manpower including;in-house intensivists,and decreasing

关键词： Intensive care unit Critical care India Survey Intensive care unit survey Intensive care unit needs

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