Prakash Kumar

Cardiac rehabilitation (CR) is a medically supervised program for patients with cardiovascular disease that aims to improve physical activity, health outcomes, psychological well-being, and quality of life. Traditional center-based CR faces challenges such as limited accessibility, high travel costs, and scheduling conflicts. Digital tools like mobile applications, videoconferencing, and artificial intelligence-based interventions offer potential solutions. This review investigates the long-term effectiveness of digital CR, considering the digital tools used, their design, and their impact over time. It also examines factors influencing the effectiveness of digital CR, including digital literacy, data security, patient adherence, lack of internet connectivity or smartphone access, and unfamiliarity with technology. Although digital interventions can be effective alternatives to center-based CR, addressing these challenges is essential for sustainable care. Overall, the study highlights the positive impact of digital CR on health outcomes and quality of life for patients with cardiovascular disease.

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Cardiovascular diseases (CVDs) are the leading cause of non-communicable disease (NCD) deaths in India, accounting for nearly 48% of all NCD mortality. [1] The risk of CVD in Indians is 3–4 times higher than that of White Americans, sixfold higher than that of Chinese, and twentyfold higher than that of the Japanese populations. Additionally, Indians tend to develop CVD at a younger age, highlighting the need to address factors beyond modifiable risk factors. Therefore, it seems prudent that CV risk should be managed more aggressively in Indian patients. [2]

AUTHOR(S): Prakash Kumar, Rajesh Baitha, Mukesh Kumar, Shikandar Prasad, Anand Prakash, Raushani Suman ABSTRACT

Composer G.V. Prakash Kumar and Sivakarthikeyan of Parasakthi fame also took to social media to express their disappointment …read more

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BackgroundFirst-trimester combined screening using biochemical and ultrasonographic markers is widely employed for early identification of pregnancies at increased risk for fetal screening-based high risk status. However, contemporary Indian data evaluating the performance of these screening markers and their follow-up outcomes remain limited.ObjectivesTo evaluate the association of maternal clinico-demographic characteristics and first-trimester biochemical and ultrasonographic markers with chromosomal anomaly risk status and to assess follow-up outcomes of high-risk pregnancies.MethodsThis retrospective cross-sectional analytical study included 164 pregnant women who underwent first-trimester aneuploidy screening between 11 and 13+6 weeks of gestation at a tertiary care centre. Maternal demographic characteristics, biochemical markers [free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A)], and ultrasonographic parameters [nuchal translucency (NT) and crown-rump length (CRL)] were analysed. Statistical analyses included Fisher's exact test, Fisher-Freeman-Halton exact test, Mann-Whitney U test, Spearman's correlation analysis, and receiver operating characteristic (ROC) curve analysis to evaluate the discriminatory performance of biochemical markers for identifying pregnancies classified as high risk by first-trimester screening.ResultsOf the 164 participants, 10 (6.1%) were classified as high risk for chromosomal anomalies. Maternal clinico-demographic variables showed no significant association with high risk of chromosomal anomaly, except for the gravida category (p=0.026). High-risk pregnancies demonstrated significantly higher free β-hCG levels and free β-hCG multiples of the median (MoM) values and significantly lower PAPP-A and PAPP-A MoM values compared with low-risk pregnancies (all p<0.01). NT thickness also differed significantly between groups (p=0.042), whereas CRL showed no significant difference. ROC analysis demonstrated good predictive performance for free β-hCG MoM (AUC=0.76, p=0.006), while low PAPP-A MoM showed excellent discriminatory performance after inversion of direction [area under the curve (AUC)=0.937], indicating a strong association with screening-based high-risk status. All 10 high-risk pregnancies underwent non-invasive prenatal testing (NIPT); one pregnancy had a high-risk NIPT result that was subsequently confirmed by amniocentesis as a chromosomal anomaly, resulting in medical termination of pregnancy.ConclusionCombined first-trimester screening using free β-hCG, PAPP-A, and ultrasonographic assessment effectively identified pregnancies at increased screening risk for fetal chromosomal abnormalities. These findings should be interpreted cautiously because only one chromosomal abnormality was confirmed.