Biomedical subjects

Deepak Goyal

Publications and source records attributed to Deepak Goyal.

6 recordsLinked to original sources

PubMed2006

South Asian or Afro-Caribbean ethnicity is not associated with altered 1 min heart rate recovery estimates in suspected coronary artery disease patients.

Heart rate recovery following a Bruce exercise protocol provides prognostic information on survival. We investigated the impact of ethnicity on HRR in 271 consecutive patients being assessed for CAD in three main ethnic groups (Caucasian (C); South Asian (SA); Afro-Caribbean (AC)). Our sample contained greater referral of younger, male South Asian subjects than would be expected on the basis of census data. The AC group had a low frequency of typical ischaemic pain. The SA sub-group, despite greater prevalence of diabetes, had marginally better HRR and a more preserved response to exercise. Multiple regression analysis revealed that age and not ethnicity was the main independent predictor of HRR (p=0.007) with all three ethnic sub-groups having a similar range of exercise time. There was no evidence of under referral of ethnic minorities. Ethnic effects in raw HRR data are most likely confounded by age.

Asia, Southeastern↗

PubMed2006

Ximelagatran.

Despite the significant advances over the last 50 years with regard to anticoagulant therapy, warfarin remains the definitive standard for the long-term prevention of thromboembolic events in at-risk patients, except those with acute coronary syndromes, in which antiplatelets are preferred. Ximelagatran, a prodrug of melagatran, is an orally administered direct thrombin inhibitor whose therapeutic potential has been investigated in venous thromboembolism, acute coronary syndromes and prevention of stroke in atrial fibrillation. Clinical studies have demonstrated ximelagatran to be comparable in efficacy to the oral vitamin K antagonist warfarin and low molecular weight heparin for prophylaxis of venous thromboembolism, comparable to warfarin for stroke prevention in the setting of atrial fibrillation, and, when combined with aspirin, more effective than aspirin alone at preventing major adverse cardiovascular events in patients with a recent myocardial infarction. Double-blind trials have also revealed the efficacy of ximelagatran in the secondary prevention of venous thromboembolism and shown the agent to be as effective as enoxaparin/warfarin in treating patients with acute deep vein thrombosis. Adverse effects with ximelagatran include elevations in alanine transaminase (ALT), which may require monitoring, and bleeding complications. Bleeding complications appear to be less than or at least comparable to those occurring with standard anticoagulant treatments like warfarin or low molecular weight heparin. In addition to its favorable efficacy and safety profile in comparison with standard anticoagulant therapy, the convenience of its oral, fixed-dose administration without the need for anticoagulation monitoring might help encourage a wider use of appropriate anticoagulation using ximelagatran across the population at risk, reducing the incidence of thromboembolic events.

Administration, Oral↗

PubMed2006

Perception of symptoms in hypertensive patients and the relevance to the application of anti- hypertensive drug therapy.

While symptoms are common during the detection and treatment of hypertensive patients it is rarely the case that either uncomplicated essential hypertension (of whatever severity) or treatment presents insurmountable problems. Unfortunately they frequently result in changes in effective therapy or encourage clinicians and prescribers to settle with altered and inadequate treatment goals. This review considers the association of patients' symptoms in the management of hypertension. It considers the relationship of symptoms at the time of diagnosis and the impact of symptoms voiced during active drug treatment. The data relating antihypertensive therapy to adverse symptoms during chronic therapy and the consequences of this on treatment goals are summarised.

Adrenergic beta-Antagonists↗

PubMed2005

Ambulatory blood pressure monitoring in heart failure: a systematic review.

Ambulatory blood pressure monitoring has established its use in the definition of white coat hypertension and monitoring of treatment of essential hypertension. Any role for ambulatory blood pressure monitoring in heart failure is not well defined. However, from the limited studies available, ambulatory blood pressure monitoring may be used to optimise heart failure therapy, and as a prognosis marker in this patient group. Most studies that have examined the circadian pressure profile have found blunting of decline of blood pressure during sleep in patients with heart failure. In advanced heart failure, this may be due to hypoperfusion of vital organs partly due to pump failure and partly due to multiple drug therapy associated with the treatment of heart failure. Ambulatory blood pressure monitoring may also clarify hypoperfusion effects on vital organs in individual patients and improve the risk/benefit ratio of treatments in advanced heart failure. Prospective controlled studies on the impact of treatments on circadian blood pressure profile in congestive heart failure patients are needed.

Blood Pressure Monitoring, Ambulatory↗

PubMed2005

Thrombotic complications and thromboprophylaxis in breast and gynaecological malignancies.

PURPOSE OF REVIEW: Thrombotic complications are a common cause of morbidity and mortality in patients with gynaecological or advanced breast malignancies. There are several manifestations of thromboembolism in these patients, but deep venous thrombosis of the legs is the usual presentation. This review highlights various manifestations of thrombotic complications in these malignancies, and also describes the current evidence base for various forms of thromboprophylaxis. RECENT FINDINGS: Several trials have suggested that low molecular weight heparin therapy is at least as effective as oral anticoagulation for secondary prophylaxis. It has also been suggested that low molecular weight heparin therapy may prolong survival in cancer patients, but this was not shown in the results of one recently published placebo-controlled randomized trial. SUMMARY: Primary thromboprophylaxis in cancer should be individualized and considered according to the risk category of each patient. Low molecular weight heparin therapy can be used for secondary thromboprophylaxis in patients with breast or gynaecological malignancy. However, more studies are needed to substantiate their acceptance in cancer patients.

Administration, Oral↗

PubMed2004

Diastolic heart failure: recognition, diagnosis and management.

A variety of community-based epidemiological studies have suggested that 30-50% of patients with heart failure symptoms appear to have preserved left ventricular (LV) systolic function when assessed by echocardiography or similar techniques suggesting 'diastolic heart failure' (DHF) as its cause. The prognosis of these patients is characterised by morbidity and mortality similar to, but less overt than, patients with systolic dysfunction. However, rates of readmission for symptom control are broadly similar in patients with DHF or in those with systolic impairment. Thus, there are many similarities in the portrayal of both systolic and DHF but equally; there are also many key differences. Certainly, while there are several successful therapies for patients with systolic heart failure, the management of patients with DHF is poorly defined. In this review, the gaps in current knowledge and practice, which is creating this therapeutic void will be addressed.

Anti-Arrhythmia Agents↗