Medicine

Comparison of 3 Dual Single-Pill Combinations for Blood Pressure Lowering: A Secondary Analysis of an International Randomized Trial

2026-01-01T00:00:00Z

Comparison of 3 Dual Single-Pill Combinations for Blood Pressure Lowering: A Secondary Analysis of an International Randomized Trial Schutte, A.E.; Salam, A.; Cushman, W.C.; De Silva, H.A.; Di Tanna, G.L.; Grobbee, D.E.; Narkiewicz, K.; Ojji, D.P.; Poulter, N.R.; Schlaich, M.P.; Spiering, W.; Williams, B.; Wright Jr, J.T.; Kumanan, T.; Hay, P.; Galappatthy, G.; Pereira, T.; Rahuman, F.; De Silva, A.P.; Constantine, G.; Gianacas, C.; Vander Hoorn, S.; Shanthakumar, M.; Liu, X.; Wang, N.; Gnanenthiran, S.R.; Whelton, P.K.; Rodgers, A.; GMRx2 Recent clinical practice guidelines recommend dual low-dose single-pill combination therapy for initial treatment of hypertension, given the improvements in efficacy, adherence, and reduction in therapeutic inertia that they impart without compromising tolerability.1 However, randomized comparisons between different dual single-pill combinations are limited. We therefore report the comparative efficacy of 3 dual combinations, each containing 2 of the major antihypertensive drug classes: an angiotensin receptor blocker (telmisartan), a dihydropyridine calcium channel blocker (amlodipine), and a thiazide-like diuretic (indapamide). This analysis was embedded in a previously reported trial in 7 countries.2 Ethics approval was obtained in each country; all participants provided informed consent. After a 4-week single-blind run-in with low-dose triple therapy (20 mg of telmisartan, 2.5 mg of amlodipine, and 1.25 mg of indapamide), participants were randomized to triple therapy or one of its 3 dual combinations at the same doses as the triple therapy: telmisartan-indapamide (TI), telmisartan-amlodipine (TA), or amlodipine-indapamide (AI). After 6 weeks, doses were doubled unless contraindicated. The primary efficacy outcome was change in mean home systolic blood pressure (BP) from randomization to week 12, analyzed using hierarchical linear modeling with final systolic BP (SBP) as the model outcome and controlling for baseline SBP, treatment arm, and visit. Huber-White sandwich estimation and covariance matrices accounted for clustering within patient and site. The primary safety outcome was treatment withdrawal attributable to adverse events. Because the parent trial was designed to compare triple therapy with each dual therapy, dual-versus-dual comparisons should be interpreted as exploratory (Trial registration: NCT04518293). Documentation around the analyses presented here will be made available to qualified scientific and medical researchers, upon researcher’s request, as necessary for conducting legitimate research. Patient data will be deidentified and will be shared via a secure means. Requests for data will only be reviewed after approval of the product in the United States and the European Union, and after approval by George Medicines of its data access request and receipt of its executed data sharing agreement. A request form can be obtained by email to the corresponding author or to info@georgemedicines. com. After the 4-week run, 834 participants with an SBP 110 to 154 mm Hg were randomized to dual therapy, with similar baseline characteristics across groups

Predictive Performance of Cardiometabolic Indices for Metabolic Syndrome among Adults in Northern Sri Lanka

2026-01-01T00:00:00Z

Predictive Performance of Cardiometabolic Indices for Metabolic Syndrome among Adults in Northern Sri Lanka Madhurahini, R.; Viveka, M.; Arasaratnam, V.; Kumanan, T. Introduction and Objectives: Metabolic syndrome (MetS) raises cardiovascular and Type 2 diabetes risk in South Asia. Simple indices enhance early detection and risk stratification. This study assessed the predictive performance of Atherogenic Index of Plasma (AIP), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI) and Cardiometabolic Index (CMI) in identifying MetS. Methods: A community-based cross-sectional study was conducted among 753 adults from rural and urban Northern Sri Lanka. Anthropometric and biochemical measurements were made using standardised procedures and cardiometabolic indices were calculated using established formulas. MetS was defined by IDF criteria. Associations were assessed using logistic regression, and predictive performance was evaluated using Receiver Operating Characteristic (ROC) curves. Results: All the cardiometabolic indices were significantly associated with MetS (p<0.001). In age- and gender-adjusted models, AIP showed the strongest association (OR = 72.58), followed by CMI (OR = 14.63), VAI (OR = 2.05), and LAP (OR = 1.08). ROC analysis demonstrated that LAP had the highest diagnostic performance (AUC = 0.904), followed by CMI (AUC = 0.833), VAI (AUC = 0.818), and AIP (AUC = 0.777). The optimal cut-off values were 32.84 cm.mmol/L for LAP (sensitivity 88.9%, specificity 78.5%), 0.615 for CMI (sensitivity 79.3%, specificity 75.2%), 1.985 for VAI (sensitivity 78.8%, specificity 74.1%), and 0.055 for AIP (sensitivity 76.4%, specificity 70.5%). Conclusion: All indices were significantly associated with MetS, though predictive performance varied. LAP showed the best performance and may be preferred for screening, while other indices can support risk assessment in a low middle income country like Sri Lanka.

Rare presentation of a prostatic carcinoma as pyrexia of unknown origin: A case report

2026-01-01T00:00:00Z

Rare presentation of a prostatic carcinoma as pyrexia of unknown origin: A case report Navakumaran, M.; Suganthan, N.; Kumanan, T.; Sujanitha, V.

Visual Outcomes of Cataract Surgery at a Tertiary Care Hospital in Northern Sri Lanka

2026-01-01T00:00:00Z

Visual Outcomes of Cataract Surgery at a Tertiary Care Hospital in Northern Sri Lanka Kumanan, T.; Malaravan, M.; Kumaran, S.; Arulijenani, K.; Powsiga, U.; Thurga, J. Background: Cataract is the leading cause of blindness and visual impairment. Cataract surgery is the most common procedure for restoring vision in individuals with cataracts. It is important to assess the surgical outcomes of cataract surgery to ensure the highest standard of vision restoration, improved patient quality of life, and service delivery. Therefore, the present study aimed to evaluate the visual outcomes of cataract surgery among patients attending the Eye Unit of Teaching Hospital Jaffna, Northern Sri Lanka, at the fourth week follow-up postoperatively. Methods: An institution-based, retrospective analytical study design was conducted among 1,133 patients who underwent cataract surgery using phacoemulsification with intraocular lens implantation. The study participants were selected using a systematic random sampling technique. Data were obtained through a structured data extraction form derived from patients’ medical records and an interviewer-administered questionnaire, and were subsequently analysed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Proportions, summary statistics, and tables were used to present the findings. Multivariable linear regression was performed to identify associations among the variables. A p‑value of <0.05 was considered indicative of statistical significance. Results: Among 1,133 patients who underwent phacoemulsification with intraocular lens implantation, 1,027 (90.6%) achieved good postoperative visual outcomes of 6/12 or better. The majority, 699 (61.7%), were female, and 800 (70.6%) were aged 60 years and above. The most common systemic comorbidities were hypertension with 386 (34.1%) patients and diabetes mellitus with 350 (30.9%), while 24 (2.1%) of them had pre-existing ocular comorbidities. Patients aged 60 years and above demonstrated significantly less improvement in visual acuity than those aged <60 years (p < 0.001). Diabetes mellitus was independently associated with reduced postoperative visual improvement (p = 0.014), whereas sex and pre-existing ocular comorbidities were not. Conclusion: The visual outcome following cataract surgery exceeds WHO recommendations. In this study, age and diabetes mellitus were associated with postoperative visual outcomes, whereas the presence of other ocular comorbidities and sex were not. Furthermore, this study demonstrates that good postoperative visual outcomes can be achieved with cataract surgery even in resource-constrained settings.