A study of hypertension epidemiology among urban population of Malwa region, India

Background: Hypertension (HTN) is the leading risk factor for cardiovascular disease and mortality worldwide. Almost three quarters of individuals with HTN live in developing countries with limited health resources and where people have low awareness of HTN and limited access to health care. Our study was thus designed to determine the prevalence, awareness, treatment, and control rates of HTN.Methods: We conducted a cross-sectional survey in different areas of urban Indore. Inclusion criteria were adults older than 21 years who gave oral consent to participate. There were no exclusion criteria. Data were collected on demographic variables, socio-economic status, presence of other cardiovascular risk factors, and medication use. BP was measured after at least 10 minutes of rest in the sitting position. Data analysis was done with Statistical Product and Service Solutions (SPSS) Statistics version 17.0 (Chicago IL, USA).Results: From December 2014 to May 2015, a total of 1697 participants were enrolled in the study. Their mean age was 42.9 years and 56% were men. The crude prevalence of HTN in our study was 36.9%. The prevalence of HTN was higher in men compared with women and increased with increasing age groups. In addition, HTN was more prevalent in patients who smoked, patients with diabetes, patients with higher BMI, and those who were married, divorced, or widowed compared with singles. HTN awareness was 53%. Among “aware” participants, 93% were taking BP-lowering therapy. Among treated participants, 54% had their BP under control during the examination. This translates into an overall 27% control rate when all hypertensive patients were considered (treated and not treated).Conclusions: Our results confirm the importance of the HTN epidemic; only one third of participants have optimal BP levels and the remaining two thirds are either hypertensive or prehypertensive. Men in particular are severely affected by the disease: 43% and 35% have either HTN or pre-HTN. Their awareness, treatment, and overall control rates are lower than those of women.

Mean platelet volume as an indicator of severity of hypertensive retinopathy in hypertensive subjects

Background: Hypertensive retinopathy (HR) represents the ophthalmic findings of end-organ damage secondary to systemic arterial hypertension. Platelets play a crucial role in the pathogenesis of atherosclerotic complications, contributing to thrombus formation or apposition after plaque rupture. The aim of our study was to investigate whether Mean platelet volume (MPV) is associated with the severity of hypertensive retinopathy in hypertensive patients.Methods: This cross-sectional study was conducted in Department of Medicine of SAMC and PGI, Indore. Total 250 adult hypertensive patients (BP >140/90 mm Hg or taking antihypertensive drugs) recruited for the study.Results: Of the 250 subjects, 158 (63.2%) were male and 92 (36.8%) were female. Elevated MPV >11.5 femtoliter was observed in 84 cases (33.6%). There was statistically significant relationship between the grade of retinopathy and elevated MPV in hypertensive subjects. (r = 0.52, P <0.001).Conclusions: We described a relation between MPV and HR (probably first time in Indian patients). Measurement of MPV is easy to establish and therefore might serve as a valuable predictor of a worse outcome in microvascular complications

Carotid intima medial thickness as a marker of atherosclerosis in ankylosing spondylitis

Background: Ankylosing Spondylitis (AS) is an inflammatory disorder of unknown cause that primarily affects the axial skeleton; peripheral joints and extraarticular structures are also frequently involved. The present study was planned to generate more data on this subject with the aim of measuring the CIMT in AS, as these patients are more prone to develop early atherosclerosis and develop early macro vascular complications like CAD.Methods: It was a cross-sectional study with a sample size of 60 patients. The study group included 30 patients with a known history or clinical features suggestive of AS. The control group included 30 normal adult subjects without any previous history. All subjects included in the study underwent detailed clinical history, analysis, physical examination and necessary investigations.Results: CIMT in the control group was 0.54±0.19 mm and in the AS group was 0.65±0.21 mm. The difference was found to be statistically significant (P0.05), showing comparable age between the two groups. The age to CIMT showed positive correlation which was statistically significant (r=0.405, p=0.026).Conclusions: Results of this study showed that there is a higher prevalence of subclinical atherosclerosis (20%) in AS patients as compared to controls as evidenced by a higher CIMT. Every effort should be made in order to control inflammation and traditional risk factors in this population, to avoid the consequences of accelerated atherogenesis

Evaluation of prescribing pattern of drugs and compliance to standard treatment guidelines in patients of chronic hepatitis B: a prospective observational study

Background: Hepatitis B is a major global health problem. Chronic hepatitis B is characterized by hepatic inflammation, necrosis and persistence of HbsAg for at least 6 months. Chronic liver disease is more predictably associated with impaired metabolism of drugs than acute liver dysfunction. Prescribing drugs in patients with chronic hepatitis B is challenging because of concerns that the drug may exacerbate the liver disease. There is also the fear that the altered liver state may change metabolism and excretion of the drug. Methods: A cross-sectional prospective study was conducted involving patients diagnosed with chronic hepatitis B at the liver clinic outpatient department (OPD) of AIIMS Bhopal. A total of 102 patients with chronic hepatitis B who met the inclusion criteria were recruited in the study. Results: Out of 102 prescriptions, 492 drugs were prescribed for the 102 patients. Out of 102 patients, 81 patients (81.66%) were on entecavir monotherapy and rest 21 patients (18.34%) were on tenofovir disoproxil fumarate (TDF) monotherapy. Of the 102-prescription issued, 92.15% (94/102) were compliant and 7.85% (8/102) were noncompliant.  Conclusions: Entecavir was the most common antiviral drug prescribed, followed by tenofovir in patients of chronic hepatitis B. Spironolactone plus torasemide combination was the most common fixed dose combination used among study participants. Liver cirrhosis followed by portal hypertension was the most common complication. Majority of prescriptions were compliant with recommendations for pharmacotherapy and safety guidelines in patients of chronic hepatitis B.

Toluene-induced acute lung injury

Toluene inhalation is an important occupational health hazard in persons working in factories manufacturing paint, chemicals, pharmaceuticals, and rubber. The present report describes an unusual case of toluene-induced acute lung injury threatening life

A Case Report of Reversible Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is mostly an idiopathic disease with a progressive and irreversible course. It carries poor prognosis and outcome. Rarely, a reversible metabolic etiology that is amenable to specific therapy is identified. Alteration in thyroid status can lead to changes in systolic and diastolic function of left ventricle. Heart is sensitive to thyroid hormone changes, and cardiac disorders are commonly associated with both hyper and hypothyroidism. Diastolic dysfunction is the most common abnormality reported in hypothyroidism. In systolic function, prolonged systolic time interval or normal cardiac function has been reported by most workers. DCM is a rare presentation of hypothyroidism. Here, we report a case of 40-year-old female diagnosed with DCM due to hypothyroidis

A study of hypertension epidemiology among urban population of Malwa region, India

Background: Hypertension (HTN) is the leading risk factor for cardiovascular disease and mortality worldwide. Almost three quarters of individuals with HTN live in developing countries with limited health resources and where people have low awareness of HTN and limited access to health care. Our study was thus designed to determine the prevalence, awareness, treatment, and control rates of HTN.Methods: We conducted a cross-sectional survey in different areas of urban Indore. Inclusion criteria were adults older than 21 years who gave oral consent to participate. There were no exclusion criteria. Data were collected on demographic variables, socio-economic status, presence of other cardiovascular risk factors, and medication use. BP was measured after at least 10 minutes of rest in the sitting position. Data analysis was done with Statistical Product and Service Solutions (SPSS) Statistics version 17.0 (Chicago IL, USA).Results: From December 2014 to May 2015, a total of 1697 participants were enrolled in the study. Their mean age was 42.9 years and 56% were men. The crude prevalence of HTN in our study was 36.9%. The prevalence of HTN was higher in men compared with women and increased with increasing age groups. In addition, HTN was more prevalent in patients who smoked, patients with diabetes, patients with higher BMI, and those who were married, divorced, or widowed compared with singles. HTN awareness was 53%. Among “aware” participants, 93% were taking BP-lowering therapy. Among treated participants, 54% had their BP under control during the examination. This translates into an overall 27% control rate when all hypertensive patients were considered (treated and not treated).Conclusions: Our results confirm the importance of the HTN epidemic; only one third of participants have optimal BP levels and the remaining two thirds are either hypertensive or prehypertensive. Men in particular are severely affected by the disease: 43% and 35% have either HTN or pre-HTN. Their awareness, treatment, and overall control rates are lower than those of women.

Severe Vitamin D deficiency causing kyphoscoliosis

Vitamin D deficiency is common among Indian population. Women are especially at risk for severe vitamin D deficiency. The risk is higher for those who are multiparous and postmenopausal. Poor exposure to sunlight, higher latitude, winter season, inadequate diet, older age, obesity and malabsorption are also important risk factors. Symptoms of hypovitaminosis D, including diffuse or migratory pain affecting several sites (especially the shoulder, pelvis, ribcage and lower back) have also been misdiagnosed as musculoskeletal disorders, including fibromyalgia, polymyalgia rheumatica and ankylosing spondylitis. Here, we report two cases presented with kyphoscoliosis, diagnosed to have severe vitamin D deficiency

Guillain–Barre Syndrome following SARS-COVID-19 Infection: A Case Report from India

Severe acute respiratory syndrome coronavirus 2 (SARS-COVID-19) is a novel coronavirus that started in Wuhan City in China in December 2019. It can cause acute respiratory infection. Guillain–Barre syndrome (GBS) is an autoimmune disease characterized by rapidly progressing ascending paralysis that is triggered by an infection or immune stimulation which produces an abnormal immune response that targets peripheral nerves. In most cases, it is preceded by a bacterial or viral infection. This is a case of a 36-year-old male patient from India who developed progressive acute flaccid paralysis after SARS-COVID-19 infection. Clinical examination and lab studies lead to the diagnosis of GBS. The patient was treated with intravenous immunoglobulins and supportive treatment. Following treatment, there was a substantial improvement in weakness as reported by the patient and was confirmed by clinical evaluation. This is an uncommon manifestation of SARS-COVID-19 infection and suggests the presence of an immune-mediated process leading to damage of the nervous system

Neuromyelitis optica with Hashimoto′s thyroiditis: A new syndrome or just coincidence

Neuromyelitis optica (NMO) is an uncommon disease syndrome of the central nervous system that affects the optic nerves and spinal cord. NMO with endocrinopathies has been described as being unique to black Antillean and Afro-Brazilian women. We describe one case of NMO with hashimoto′s thyroiditis in a young female, probably first case report in India