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  Most popular articles (Since March 11, 2015)

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Chi-square test and its application in hypothesis testing
Rakesh Rana, Richa Singhal
January-April 2015, 1(1):69-71
In medical research, there are studies which often collect data on categorical variables that can be summarized as a series of counts. These counts are commonly arranged in a tabular format known as a contingency table. The chi-square test statistic can be used to evaluate whether there is an association between the rows and columns in a contingency table. More specifically, this statistic can be used to determine whether there is any difference between the study groups in the proportions of the risk factor of interest. Chi-square test and the logic of hypothesis testing were developed by Karl Pearson. This article describes in detail what is a chi-square test, on which type of data it is used, the assumptions associated with its application, how to manually calculate it and how to make use of an online calculator for calculating the Chi-square statistics and its associated P-value.
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Commonly used t-tests in medical research
RM Pandey
May-August 2015, 1(2):185-188
Student's t-test is a method of testing hypotheses about the mean of a small sample drawn from a normally distributed population when the population standard deviation is unknown. In 1908 William Sealy Gosset, an Englishman publishing under the pseudonym Student, developed the t-test. This article discusses the types of T test and shows a simple way of doing a T test.
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Prosthetic heart valve thrombosis: Diagnosis and newer thrombolytic regimes
Shanmugam Krishnan
January-April 2016, 2(1):7-12
Prosthetic heart valve thrombosis incidence is high in developing countries and contributes to significant late mortality postvalve surgery. Many guidelines advocate surgery as the first line therapy though thrombolysis is often used in many centers. In this article, we review the newer regimens of fibrin-specific thrombolytics. Newer regimens of very low-dose, slow infusion lead to equal efficacy with lower complication in majority of patients. Patients with the New York Heart Association (NYHA) Class I–II who have low thrombus burden should receive thrombolysis with low-dose slow infusion while those with high thrombus burden should be planned for surgery. Patients presenting with NYHA Class IV should be treated with classical dose thrombolysis.
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Hippocrates and the hippocratic oath
Saurabh K Gupta
January-April 2015, 1(1):81-86
For a long-time men had a philosophic view of health and disease, and this lasted till almost 2500 years back. Hippocrates, the great Greek physician, is believed to have seperated the "art of healing" and philosophy. An astute observer, Hippocrates during his practice employed principles that laid the foundation of modern medicine. The medical fraternity worldwide unanimously bestowed the title of "father of medicine" to this great man. Apart from being a physician, he was instrumental in bringing about the concept of ethics in the realm of medicine. The famous document "Hippocratic Oath" while being respected by almost all has generated a great amount of debate among historians. Nonetheless, almost all medical schools across the world have the Oath ceremony where medical graduates agree to the commandments of the Hippocratic Oath, either in its original or modified form. Although a statement of promise this Oath does not have any legal implications as might be seen by a person outside the medical community. This article outlines the contributions made by Hippocrates to the medical world with an emphasis on the Hippocratic Oath.
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Heart failure in India: The INDUS (INDia Ukieri Study) study
Vivek Chaturvedi, Neeraj Parakh, Sandeep Seth, Balram Bhargava, S Ramakrishnan, Ambuj Roy, Anita Saxena, Namit Gupta, Puneet Misra, Sanjay Kumar Rai, K Anand, Chandrakant S Pandav, Rakesh Sharma, Sanjay Prasad
January-April 2016, 2(1):28-35
Introduction: There are few data on heart failure (HF) burden and none available on the community prevalence of HF in India. We conducted a study aimed at determining the HF prevalence in a rural community as well as tertiary hospital care setting in North India. We also reviewed the existing literature regarding the estimated and projected prevalence of HF in India. Methodology: All adults (>20 years) with chronic breathlessness in six villages under a primary health care center in Northern India were identified and evaluated with standardized questionnaire and physical examination by trained health care workers. HF was diagnosed by standardized criteria and a transthoracic echocardiogram was performed in all subjects. In the hospital study, 500 consecutive patients presenting to our tertiary referral hospital were evaluated for the diagnosis of HF. For the systematic review, all published studies addressing HF or the burden of risk factors in India were identified. Projections for the absolute HF burden were made using local data and global studies of HF incidence, morbidity, and mortality. Results: Among the surveyed rural adult population of 10,163 patients, chronic breathlessness was present in 128 (1.3%). HF was present in 9% (n = 12), of which 67% (n = 8) had preserved left ventricular (LV) systolic function and 33% (n = 4) had LV systolic dysfunction. Therefore, the prevalence of HF in this general community was 1.2/1000. All patients with HF and preserved ejection fraction had poorly controlled hypertension. In the hospital study, of 500 consecutive patients, 20.4% had HF. Rheumatic heart disease (52%) was the most common cause followed by ischemic heart disease (17%). The mean age of presentation was 39 ± 16 years. The prevalence of HF in the outpatient department patients was 22.5% below 30 years and 14.9% above 50 years, reflecting the young population of HF. For the estimates concerning HF burden in India, projections were made using both age-specific extrapolations from developing countries and data regarding development of HF in the presence of risk factors. The estimated prevalence of HF is about 1% of the total population or about 8–10 million individuals. The estimated mortality attributable to HF is about 0.1–0.16 million individuals per year. Conclusions: While our hospital data are consistent with the HF burden and etiology expected in a government tertiary hospital setting, our community-based study is the first of its kind reported from India. The community study demonstrates a surprisingly low prevalence of symptomatic HF in the surveyed villages. This could be partially explained by the rural farming-based community setting but is also likely due to under-reporting of symptoms. Our review of the projected national estimates suggests an alarming burden of HF in India despite a younger population than the developed nations. A significant proportion of this burden may be preventable with better screening and early and adequate treatment of the risk factors.
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A case of right sided heart failure
Siddharthan Deepti, Saurabh Kumar Gupta
May-August 2015, 1(2):130-137
A patient of dominant right sided heart failure for 7 years is presented and discussed, starting from the history and examination findings and going on to all the investigations. The clinical findings, along with the electrocardiogram, chest X-ray, echocardiogram, and cardiac computed tomography are used to arrive at a diagnosis of chronic constrictive pericarditis. The differential diagnosis at each stage of presentation are presented and discussed.
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Implications of 2017 hypertension guidelines for Indian patients
Rajiv Narang, S Srikant
January-April 2018, 4(1):3-5
The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg.The new guideline adopts a key component of the 2013 cholesterol guideline and incorporates overall cardiovascular risk. The AAFP has decided to not endorse the recent hypertension guideline because it gave undue importance to the SPRINT trial and cardiovascular risk which was not validated and would lead to overtreatment. The guidelines are discussed in this article.
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Development of mechanical heart valves - an inspiring tale
P Rajashekar
September-December 2015, 1(3):289-293
The historical evolution of the prosthetic heart valves from the first attempts with the Hufnagel's valve in the treatment of the aortic insufficiency to the Starr-Edwards' ball valve and later the tilting disc valves (Bjork-Shiley etc.,) and finally the bileaflet valves (St. Jude) are discussed. The Indian contribution with Chitra valve is also described.
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Decoding the Bland–Altman plot: Basic review
Aakshi Kalra
January-April 2017, 3(1):36-38
The Bland–Altman plot is a method for comparing two measurements of the same variable. The concept is that X-axis is the mean of your two measurements, and the Y-axis is the difference between the two measurements. The chart can then highlight anomalies, for example, if one method always gives too high a result, then all points are above or below the zero line. It can also reveal that one method overestimates high values and underestimates low values. If the points on the Bland–Altman plot are scattered all over the place, above and below zero, then it suggests that there is no consistent bias of one approach versus the other. It is, therefore, a good first step for two measurement techniques of a variable.
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Genexpert technology: A new ray of hope for the diagnosis of tuberculour pericardial effusion
Neema Negi, Bimal Kumar Das
September-December 2015, 1(3):233-240
Tuberculous pericardial effusion is a well-known complication of tuberculosis (TB). However, the greatest challenge in front of clinicians is its diagnosis as the conventional methods lack the required sensitivity and specificity of detection. The emergence of drug resistance and co-infections such as human immunodeficiency virus further complicates the situation making it difficult to diagnose such cases. GeneXpert technology is a major breakthrough in the field of TB diagnosis and has opened newer avenues for many new molecular tests to be launched in the future. The World Health Organization endorsed this technology in 2010 for rapid and simultaneous detection of Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. GeneXpert-MTB/RIF assay was highly recommended as an initial diagnostic platform in high burden countries for early and quick detection of TB cases. Until date, very few studies have evaluated the performance of this brilliant assay in pericardial effusion cases, thus, more studies are required to address the unanswered questions left so far. Our review attempts to recapitulate the achievements, the potential impacts and the prospective use of this novel technology in early diagnosis of TB, especially focussing pericardial effusion cases.
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Epidemiology of cardiomyopathy - A clinical and genetic study of dilated cardiomyopathy: The EPOCH-D study
Soumi Das, Amitabh Biswas, Mitali Kapoor, Sandeep Seth, Balram Bhargava, Vadlamudi R Rao
January-April 2015, 1(1):30-34
Background: Dilated Cardiomyopathy (DCM) is a genetic disorder where a heterogeneous group of cardiac-muscles are involved and is characterized by ventricular dilatation, impaired systolic function, reduced myocardial contractility with left ventricular ejection fraction (LVEF) less than 40%. Our study aims to report the Demographic, Clinical and Genetic profile of Indian Dilated Cardiomyopathy patients. Methodology: All patients were recruited with prior written informed consent and are of Indian origin. Results: In a total of 80 DCM patients, the prevalence was higher among males. In males, mean age of onset was comparatively less than females. In this cohort, 40% had familial inheritance. Sixty two percent of DCM patients belong to NYHA functional class II with ejection fraction (EF) ranging between 21-30% and, around one third of the patients had atrial fibrillation (AF). Genetic screening revealed a novel splice site mutation LMNA (c.639+ G>C) and a rare variant MYH7 (c.2769 C>T) in a patient and insilico analysis of both variants suggested functional changes that were considered pathogenic. We report 3% and 4% occurance of variants, each in LMNA and MYH7, where as reported frequencies of these genes are 6% LMNA and 4% MYH7. Conclusions: DCM is often familial and all possible candidate genes should be screened to identify mutations. Such type of exercise may help in the identification of mechanistic pathways. Next generation sequencing platforms may play an important role in this respect in future.
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Cyanosis in a patient with atrial septal defect
Vikas Thakran, Anunay Gupta
January-April 2015, 1(1):74-75
Cyanosis in ASD has multiple causes requiring etiology directed management. Cyanosis can present in the setting of elevated pulmonary artery pressure, as in Eisenmenger syndromes having a poor prognosis. Conversely, cyanosis may present in patients having normal pulmonary artery pressure with potentially treatable conditions.
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Case of cyanotic congenital heart disease
Shanmugam Krishnan, Preetam Krishnamurthy, S Ramakrishnan, Saurabh Gupta
May-August 2016, 2(2):114-119
A adult patient presented with cyanosis since early childhood. The clinical approach to such a patient, including review of the ecg, chest xray and echocardiogram is presented. Various aspects of the bedside approach to adult cyanotic heart disease are discussed
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Requiem for the steth? Not Yet: Are you Listening?
Sandeep Seth, Shyamal K Goswami, Balram Bhargava, Sanjay Prasad, Mark Huffman
September-December 2015, 1(3):225-226
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Burden of atrial fibrillation in India
Vijay Bohra, Gautam Sharma, Rajnish Juneja
September-December 2015, 1(3):230-232
Atrial fibrillation (AF) is becoming a major public health burden worldwide, and its prevalence is set to increase owing to the increase in the elderly population. Despite the availability of good epidemiological data on the prevalence of AF in the Western countries, the corresponding data are limited from our country. In this article, we have tried to assimilate all the data available. A national registry on AF does provide some insight into the causes and effects. It is necessary to have a precise knowledge of the national burden for formulating national evidence-based policy and guidelines.
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Department of Cardiology, All India Institute of Medical Sciences
Sivasubramanian Ramakrishnan, Sudha Bhushan
January-April 2016, 2(1):52-54
Cardiology developed in India in the 1950's and 1960's with the setting up of the Departments of Cardiology in Vellore, in AIIMS, and in many other colleges all over India. History teaches us many lessons and meeting some of the stalwarts who made this history inspires us to greater heights. In February 2016, AIIMS organized an alumni event in which many of the old faculty and students got together. We bring together some photographs and videos. We also invite everyone to send more photographs and thoughts to the journal for further compilation.
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Adolf Kussmaul and Kussmaul's sign
Navreet Singh, Devinder Singh Chadha, Prashant Bharadwaj, Naveen Agarwal
May-August 2015, 1(2):128-129
Kussmaul's has provided us with three important signs: Pulses paradoxus, Kussmaul's sign and Kussmaul Breathing. This article discusses Kussmaul's sign, its discovery, first description, pathophyiology and exceptions.
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Deciphering the dilemma of parametric and nonparametric tests
Rakesh Kumar Rana, Richa Singhal, Pamila Dua
May-August 2016, 2(2):95-98
The potential source of complexity while analyzing the data is to choose on whether the data collected could be analyzed properly by the application of parametric tests or nonparametric tests. This concern cannot be underrated as there are certain assumptions which should be fulfilled before analyzing the data by applying either of the two types of tests. This article describes in detail the difference between parametric and nonparametric tests, when to apply which and the advantages of using one over the other.
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Health Ministry's Screening Committee (Indian Council of Medical Research)
Sandeep Seth
May-August 2015, 1(2):216-217
The Health Ministry's Screening Committee (Indian Council of Medical Research) takes decisions on the international research proposals in the field of health research, requiring foreign collaboration and assistance from foreign funding agencies.
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Remembering Dr. Rajnish Juneja

January-April 2018, 4(1):62-62
  2,609 153 -
Epidemiology of cardiomyopathy - A clinical and genetic study of hypertrophic cardiomyopathy: The EPOCH-H study
Amitabh Biswas, Soumi Das, Mitali Kapoor, Sandeep Seth, Balram Bhargava, Vadlamudi Raghavendra Rao
May-August 2015, 1(2):143-149
Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder with the prevalence of 1 in 500 globally. HCM is clinically characterized by thickening of the wall of the heart, predominantly left ventricle (LV), and interventricular septum (IVS). Our study aims to report the demographical, clinical and genetic profile of Indian HCM patients. Methods: HCM patients were recruited on the basis of WHO criteria. The clinical phenotypes were analyzed using electrocardiography, two-dimensional electrocardiography, and hotspot region of the MYH7 gene was sequenced for all patients as well as for controls. Results: There were 59 patients with a clinical diagnosis of HCM with a preponderance of disease in males with a ratio (men, women) of 5.5:1. Average age of onset of the disease was late 30 s (39.2 ± 14.5) with familial HCM accounting for 18% (n = 9) for total HCM families (n = 50). Nonobstructive kind of HCM was more prevalent as compared to obstructive HCM (66.1% vs. 33.9%). Average posterior wall LV thickness of the HCM patients was 16 ± 4.8 mm and IVS thickness was 21 ± 8.3 mm with familial patients having greater wall thickness as compared to sporadic patients. Sequencing of hotspot region of MYH7 identified three mutations in three different patients. Two mutations were found to be segregating in familial cases. Conclusion: HCM is more prevalent in males with a predominance of hypertrophic nonobstructive cardiomyopathy form. Eighteen percent of cases were familial and showed an early onset of the disease and worse prognosis as compared to sporadic cases. Hotspot sequencing of MYH7 only explains 6% of its genetic basis. More of the candidate genes need to be screened through advanced techniques like next generation sequencing to identify the causal genes which could make us understand the mechanistic pathways.
  2,427 270 1
Indications, timing and techniques of radical pericardiectomy via modified left anterolateral thoracotomy (ukc's modification) and total pericardiectomy via median sternotomy (holman and willett) without cardiopulmonary bypass
Ujjwal Kumar Chowdhury, Rajeev Narang, Poonam Malhotra, Minati Choudhury, Arindam Choudhury, Sarvesh Pal Singh
January-April 2016, 2(1):17-27
Background: Patients with constrictive pericarditis can be treated by pericardiectomy by either left anterolateral thoracotomy or median sternotomy. The terms “radical,” “total,” “extensive,” “complete,” “subtotal,” “adequate,” “near-total,” and partial pericardiectomy have been used often without much clarity. We describe our experience with a radical pericardiectomy technique via modified left anterolateral thoracotomy and compare the same to total pericardiectomy via median sternotomy. Methods: In this study, 67 (54.9%) patients underwent radical pericardiectomy via modified left anterolateral thoracotomy (Group I), and 55 (45.1%) patients underwent total pericardiectomy via median sternotomy (Group II). Results: The operative mortalities were 2.9% and 7.2% for the radical and total pericardiectomy groups, respectively. The time taken for normalization to Class I/II in Groups I and II was 30 ± 11 and 36 ± 14 days, respectively (P = 0.009). Surgical techniques did not affect the outcome of atrial fibrillation (P = 0. 77). Reoperation was not required for any patient. The radical pericardiectomy was also associated with less postoperative low cardiac output state as compared to patients undergoing total pericardiectomy (P < 0.001). There was no difference in mean duration of hospitalization; however, the radical pericardiectomy group achieved the New York Heart Association I and II Status quicker than the total pericardiectomy group (P = 0. 009). Conclusions: We conclude that using several technical modifications of pericardial excision, it is possible to achieve radical pericardiectomy via modified left anterolateral thoracotomy, particularly removing the constricting pericardium over the anterolateral, diaphragmatic surfaces of left ventricle and the anterior and diaphragmatic surfaces of the right ventricle until the right atrioventricular groove without using cardiopulmonary bypass in the great majority of patients undergoing pericardiectomy for chronic constrictive pericarditis. Although the surgical approach for pericardiectomy is based on surgeon's preference, left anterolateral thoracotomy is the preferred and noncontroversial approach in the setting of purulent pericarditis and effusive constrictive pericarditis to prevent sternal infection. We recommend median sternotomy approach with or without cardiopulmonary bypass, in the setting of calcific pericardial patches, pericardial masses, reoperations, and calcific pericardial “cocoon” and for those with predominant right-sided and annular involvement.
  2,388 252 -
Epidemiology of acute decompensated heart failure in India : The AFAR study (Acute failure registry study)
Sandeep Seth, Suraj Khanal, Sivasubramanian Ramakrishnan, Namit Gupta, Vinay K Bahl
January-April 2015, 1(1):35-38
Objectives: There is a paucity of data on acute decompensated heart failure (ADHF) in Indian patients. We herein report the in-hospital and 6-month outcome of Indian patients admitted with ADHF. Methods: We prospectively enrolled consecutive patients with ADHF due to systolic dysfunction in the acute failure registry and followed them up for at least 6 months. We analyzed the data on death and hospitalization of the first 90 patients on death and hospitalization over 6-months. Results: A total of 90 patients were enrolled with a mean age of 53.5 ± 17. 7 years and the majority were male (63%). The mean left ventricular ejection fraction was 29.2± 11.9%. The in hospital mortality was 30.8%. Postdischarge 6-month major adverse event (re-hospitalization/mortality combined) and mortality rates were 39.5% and 26.3%, respectively. Conclusions: These data from a single referral center provide insights into the current status of acute HF care in India. We report a higher in-hospital and follow-up mortality rates in ADHF patients who present at younger ages than reported in Western literature.
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Heart failure guidelines for India: Update 2017
Sandeep Seth, S Ramakrishnan, Neeraj Parekh, G Karthikeyan, Sandeep Singh, Gautam Sharma
September-December 2017, 3(3):133-138
Heart failure (HF) is a major health problem in India with a postadmission mortality of 20%–30%. Medication adherence ranges from 25% to 50%, and the tolerance of guideline-based medication is low for Indian patients. We took out guidelines on HF in 2015, and this update covers the changes which have occurred in HF management in the past 2 years. As a number of new drugs such as angiotensin receptor-neprilysin inhibitor and ivabradine have been approved for use in India, devices such as implantable cardioverter-defibrillators and cardiac resynchronization therapy are becoming more accessible and more left ventricular assist devices and transplants are being done in India, there is need for clear guidelines for the use of each which are practical for India.
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Conference Titles, Dates and Venue

April 2016, 2(4):1-1
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