Publications by authors named "Prabhakar D"

In heart failure, sympathetic overdrive is evidenced by norepinephrine spillover, receptor level changes, etc. Beta-blockers continue to be the cornerstone of treatment in patients with chronic heart failure due to their ability to counteract sympathetic overdrive. Extensive clinical research has demonstrated that long-term beta-blocker treatment with metoprolol succinate, carvedilol, or bisoprolol enhances left ventricular function and reverses left ventricular remodeling, decreases hospitalization risk, and increases survival.

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Atherosclerotic plaque formation is a leading cause of arterial thrombosis that significantly impacts global health by instigating major adverse cardiovascular events (MACE) like myocardial infarction (MI) and stroke. Platelets are central to this process, leading to the development of antiplatelet therapies, to mitigate MACE risks. The combination of aspirin with a potent P2Y inhibitor known as dual antiplatelet therapy (DAPT) is the standard for post-percutaneous coronary intervention (PCI) aimed at reducing ischemic events.

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Adverse cardiovascular (CV) events have declined in Western countries due at least in part to aggressive risk factor control, including dyslipidemia management. The American and European (Western) dyslipidemia treatment guidelines have contributed significantly to the reduction in atherosclerotic cardiovascular disease (ASCVD) incidence in the respective populations. However, their direct extrapolation to Indian patients does not seem appropriate for the reasons described below.

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Aim: The aim of this study is to assess the effect of selected locally available beverages on salivary pH, flow rate, and oral clearance rate among adults.

Materials And Methods: A quantitative diagnostic method for dental caries would improve oral health, which directly affects the quality of life. The pH scale measures how acidic or basic a solution is, with 7 being neutral.

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  • Mastitis is a breast inflammation condition caused by various infections and non-infectious factors, which can lead to severe complications if not treated properly, often resembling breast cancer symptoms.
  • The study aimed to analyze the characteristics, causes, and clinical imaging patterns of mastitis in 65 patients over a year.
  • Results showed a mix of infectious (47.6%) and non-infectious (52%) cases, with granulomatous mastitis being particularly common, emphasizing the need for a collaborative approach in diagnosing and managing the condition.
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  • - Cancer cells can adapt their characteristics (phenotypes) to better survive in changing environments through a process called phenotypic plasticity, which provides them with a competitive edge.
  • - Recent insights suggest that new traits in cancer cells can arise not just from genetic changes but also from non-genetic factors related to their ability to change phenotype, leading to a diverse population that complicates treatment.
  • - Understanding how cancer cells modify their phenotypes through both competition and cooperation, particularly in the context of their environment and interactions, is crucial for developing innovative cancer therapies and strategies.
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Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment.

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  • * Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are new medications that not only help control blood sugar in T2DM but also provide significant cardiovascular benefits for HF patients.
  • * Evidence shows that SGLT2i can enhance heart function and improve outcomes in HF whether patients have diabetes or not, making them valuable for a wide range of HF patients, especially in India.
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  • - In India, heart failure (HF) is a significant health issue, impacting younger individuals compared to Western countries, but many patients do not receive proper medical treatment.
  • - Selective β-1 blockers, like bisoprolol, are important in treating HF because they help lower heart rate and reverse negative heart and blood vessel changes associated with the condition.
  • - Despite the benefits of bisoprolol for various HF cases and comorbid conditions, its use in India remains suboptimal, prompting a consensus on its effectiveness and recommending it for better patient care.
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  • The Lipid Association of India updated its cardiovascular risk assessment algorithm to address the unique challenges of atherosclerotic cardiovascular disease (ASCVD) in Indians, focusing on early intervention.
  • A series of expert meetings were held to review current evidence and refine treatment guidelines, emphasizing the need for aggressive preventive measures due to the young age of onset for ASCVD in the Indian population.
  • The updated recommendations aim to enhance LDL-C-lowering therapy and improve risk management strategies for individuals at high risk of ASCVD, ultimately striving to reduce its prevalence in India and beyond.
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Adverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), β-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile.

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Iron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF.

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Background Calcium-channel blockers (CCB) are a mainstay in the management of hypertension (HTN), and amlodipine is the preferred CCB due to its longer half-life and better safety. Patients and methods This practice-based, observational, real-world evidence study assessed the 24-hour ambulatory blood pressure (ABP) control in mild-to-moderate essential hypertensive patients (treatment naïve receiving amlodipine monotherapy, or as add-on therapy) in inadequately controlled blood pressure (BP goal not met after one month of existing therapy). One hundred four (62M/42F) patients between 18 and 65 years of age who received amlodipine 5/10 mg/day for >8 weeks were included after obtaining informed written consent.

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Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals.

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Patients with acute coronary syndrome (ACS) have a high risk of subsequent adverse cardiovascular outcomes, particularly within the first 30 days. Although it is well documented that initiation of statin therapy in the setting of ACS improves short- and long-term cardiovascular outcomes, and achievement of lower levels of low density lipoprotein cholesterol (LDL-C) incrementally improves outcomes, many patients with ACS have persistent hypercholesterolemia after discharge from the hospital. This is a missed opportunity that prompted the Lipid Association of India to develop recommendations for earlier initiation of more aggressive LDL-C lowering treatment, particularly for patients of South Asian descent who are well-documented to have earlier onset of more aggressive atherosclerotic cardiovascular disease.

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  • The Lipid Association of India recommends specific LDL cholesterol targets for stroke patients, with high-intensity statins as the first-line treatment and the possibility of adding nonstatin therapies if necessary.
  • Continuing statins is crucial for patients with acute ischemic stroke; those who have their statins stopped usually experience worse outcomes, while statins should not be initiated in acute intracerebral hemorrhage cases but continued if already prescribed.
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Attention-deficit/hyperactivity disorder (ADHD), characterized by inattention, impulsivity and hyperactivity is a major health problem. This paper discusses ADHD across the life span and looks at the impact of debilitating symptoms, diagnosis, and treatment in athletes. Psychosocial interventions, with or without psychopharmacology including stimulants and nonstimulants, are discussed to help athletes achieve their highest level of symptom abatement and functioning.

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Aim: Ensuring adherence to guideline-directed medical therapy (GDMT) is an effective strategy to reduce mortality and readmission rates for heart failure (HF). Use of a checklist is one of the best tools to ensure GDMT. The aim was to develop a consensus document with a robust checklist for stabilized acute decompensated HF patients with reduced ejection fraction.

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