Objective To evaluate the presentation, management, and outcomes of patients hospitalized for heart failure (HF) in Trivandrum, India. Methods The Trivandrum Heart Failure Registry (THFR) enrolled consecutive admissions from 13 urban and five rural hospitals in Trivandrum with a primary diagnosis of HF from January to December 2013. Clinical characteristics at presentation, treatment, in‐hospital outcomes, and 90‐day mortality data were collected. ‘Guideline‐based’ medical treatment was defined as the combination of beta‐blockers, angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone receptor blockers in patients with left ventricular systolic dysfunction (LVSD). Results We enrolled 1205 cases (834 men, 69%) into the registry. Mean (standard deviation) age was 61.2 (13.7) years. The most common HF aetiology was ischaemic heart disease (IHD) (72%). Heart failure with preserved ejection fraction (≥45%) constituted 26% of the population. The median hospital stay was 6 days (interquartile range = 4–9 days) with an in‐hospital mortality rate of 8.5% (95% confidence interval 6.9–10.0). The 90‐day all‐cause mortality rate was 2.43 deaths per 1000 person‐days (95% confidence interval 2.11–2.78). Guideline‐based medical treatment was given to 19% and 25% of patients with LVSD during hospital admission and at discharge, respectively. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of 90‐day mortality. Conclusion Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital‐based HF medical care in Trivandrum.

Background:Revised National Tuberculosis Control Programme (RNTCP) of Government of India provides intermittent thrice-a-week directly observed treatment short course (RNTCP regimen).Objective:Assessments of all-cause mortality and nine-month morbidity outcomes of patients with tuberculous meningitis (TBM) on RNTCP regimen.Materials and Methods:We prospectively followed up patients registered with RNTCP center, with a diagnosis of TBM from January 1st, 2010 to December 31st, 2011. Morbidity was assessed using modified Rankin Scale (mRS).Results:We had 43 patients with median duration for follow-up of 396 days and that of survivors of 425 days. Two patients defaulted. Fourteen patients (32.5%) had mRS score of 4 to 6 and 29 had mRS of 0 to 3 after 9-month treatment. Severe disability was not related to any factor on logistic regression. Severe disability was seen in one patient (6.66%) among the 15 patients with stage 1, nine (37.5%) out of 24 patients with stage 2 and three (75%) out of 4 patients with stage 3 disease. Eight patients died (18.6%) of whom 4 died during the intensive phase and 4 during the continuation phase of RNTCP regimen. Mortality was independently related to treatment failure with adjusted Hazard ratio of 8.29 (CI: 1.38-49.78) (P = 0.02). One patient (6.66%) died out of the 15 patients with stage 1 disease, 5 (20.8%) out of 24 patients with stage 2 disease and 2 (50%) out of the 4 with stage 3 disease.Discussion and Conclusion:RNTCP regimen was associated with good compliance, comparable mortality and morbidity.

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Hoarseness is a common clinical condition with underlying causes which can vary from reversible and benign to life-threatening and malignant. Cardiovocal syndrome may cause hoarseness secondary to left recurrent laryngeal nerve palsy when the recurrent laryngeal nerve is mechanically affected due to enlarged cardiovascular structures. We report a 28-year-old male who presented to the Government Medical College, Thiruvananthapuram, India, in 2013 with hoarseness. He had undergone irregular treatment for pulmonary tuberculosis (TB) two years previously. Fiber-optic laryngoscopy indicated left vocal cord palsy and a computed tomography scan of the chest revealed features of pulmonary hypertension with extensive enlargement of the pulmonary arteries. An echocardiogram confirmed severe pulmonary arterial hypertension with severe tricuspid regurgitation. He was diagnosed with left recurrent laryngeal palsy secondary to cardiovocal syndrome. Although reports exist of recurrent laryngeal palsy in TB, this case appears to be the first to report cardiovocal syndrome in a patient treated for pulmonary TB. Cardiovocal SyndromeA rare cause of hoarseness in a patient with a history of pulmonary tuberculosis Case ReportA 28-year-old male was admitted to the Government Medical College, Thiruvananthapuram, India, in 2013 with hoarseness persisting for three months. He also complained of a history of dyspnoea both upon moderate exertion during the last year and at rest over the past two days. He did not report any symptoms of coughing, haemoptysis, difficulty in swallowing, paroxysmal nocturnal dyspnoea, rheumatic fever or previous surgical interventions or trauma to the head and neck region. Two years previously, he had been diagnosed with open pulmonary TB and was prescribed a regimen of antitubercular therapy including isoniazid, rifampicin, pyrazinamide and