Study of the profile of stroke in a tertiary-care hospital in the sub-Himalayan region in north India

Background: Rapid urbanization of rural areas is predicted to increase the incidence of risk factors for vascular events such as stroke among the ruralites. A different culture, beliefs, terrain, and climatic conditions of Himachal Pradesh may have an impact on the profile of stroke. Objectives: To study the profile and the various risk factors of stroke in the sub-Himalayan region of north India. Material and Methods: It was an observational cross-sectional study conducted at the Department of Medicine, R.P. Government Medical College, Kangra, Himachal Pradesh, for a duration of 12 months, from June 2012 to May 2013. Consecutive patients presenting to the hospital with signs and symptoms of stroke were included in the study. Detailed history and clinical examination was carried out in all patients. CT scan, routine blood examination, and lipid profile were evaluated in all patients. Results: Total number of patients who presented with stroke in a year was 374. It formed 4.0% of the total hospital admissions in medical wards. The mean age of stroke patients was 66.17±12.9 years. Of the total patients, 254 (67.9%) were males and 120 (32%) were females; 127 patients (33.9%) presented between 6 am and 12 pm. The majority of patients presented in winter months, from November to January. Average delay in the presentation to hospital was 29 h. Only 79 (21.1%) patients presented within 3 h. Among the patients, 342 (91.4%) belonged to rural area, 61.4% had an infarct, and 38.6% had intracerebral bleed. The most common symptoms reported were weakness in 276 (73%) followed by speech abnormality in 53%. Hypertension as a risk factor was found in 174 (46.5%); 155 patients (41.4%) were smokers; and diabetes was present in 61 patients (16.4%). Average cholesterol level was 176±54.99 mg/dl, and average triglyceride level was 339 mg/dl. Conclusions: The major strength in our study was the predominance of rural population. The state has witnessed an increase in the incidence of stroke. Elderly population is predominantly affected. Average delay in presentation was 29 h, which is substantially high. Majority of the events occurred in winter months

Influence of sex on the profile of acute coronary syndrome: a tertiary care hospital based study from the Sub-Himalayan region in North India

Background: Coronary events presents about ten years later in women than men. There exist distinct gender differences in terms of presentation of symptoms, validity of diagnostic tests and complications. Methods: The study was conducted in the department of medicine R.P. Govt. Medical College (RPGMC) Himachal Pradesh. Consecutive 300 patients of acute coronary syndrome from June 2011 to June 2012 were included in the study. Demographical profile was recorded with focused clinical examination and relevant investigation with lipid profile was done.Results:Among the study population of 300 individuals, 201 (67%) were males and 99 (33%) were females. The mean age among male patients was 61.3±11.7 years and in female patients the mean age was 65.6±11.20 years. 68.8% of females presented after 60 yrs of age. Dyslipidemia was the commonest risk factor followed by hypertension and obesity. 12.2% of female patients were smokers. Chest pain was the commonest presenting symptom seen in 82% cases. There was mean delay of 31.0±54.5 hrs in the presentation of females for treatment. ST Elevated Myocardial Infarction occurred less frequently in females.Conclusions: Acute coronary syndrome is more age dependent in females. The predominance of dyslipidemia, hypertension and obesity as risk factors gives a message for primary care physicians to create awareness for the prevention of Acute Coronary Syndrome. The atypical symptoms should be recognised early which should further prevent the delay in presentation.

Impact of health education on knowledge and attitude of self-breast examination among female nursing students

Background: Breast cancer is the most common cancer among women and a leading cause of death worldwide, including in India. Breast cancer usually shows a slow development rate, and when it is recognized in the early stages, successful treatment results can be achieved. Breast self-examination is a screening option for young women. Health awareness programs on screening and early detection are the cornerstones for reducing the morbidity and mortality resulting from breast cancer. Objective: To assess the impact of health education on knowledge and attitude of self-breast examination among nursing students. Study Design: The present interventional study was conducted between September and October 2019. Setting: This study was done among 79 nursing students of a tertiary care hospital situated in a central district of Uttar Pradesh. Main Outcome Measures: The self-reported pre-designed and structured questionnaire was used. It included three sections: 1. Sociodemographic profile 2. Knowledge regarding self-breast examination (SBE) 3. Attitude regarding self-breast examination (SBE). Knowledge and attitude scores were calculated and divided into the poor, average, and good categories. Results: There were 87.3% of girls had prior knowledge of the self-breast examination, while 12.7% of girls were not aware of the self-breast examination. Post-intervention, there was a significant increase (p<0.05) in their knowledge about self-breast examination. Conclusion and Relevance: Planned teaching intervention had a significant impact on the knowledge and attitude of self-breast examination. The knowledge and attitude were poor at the early stages, but it had increased significantly after the health education intervention

Study of LV functions in patients of subclinical hypothyroidism in patients coming to rural medical college of Sub-Himalayan region of India

Background:Subclinical hypothyroidism (SCH) is a common disorder and has been implicated in increased cardiovascular morbidity and mortality. Therefore, it is important to study the effect of SCH on cardiac morphology and function. Thus, present study titled “Study of LV functions in patients of subclinical hypothyroidism in patients coming to rural medical of sub-Himalayan region of India” was conducted in the department of medicine, Rajinder Prasad government medical Tanda over a period of three years from December, 2010 to November, 2013 to study left ventricular function in subclinical hypothyroidism.Methods: The study was conducted in the department of medicine, Rajinder Prasad government medical Tanda over a period of three years from December, 2010 to November, 2013 to study left ventricular function in subclinical hypothyroidism. The data was analysed using computer software Epi-info version 6.0 and SPSS version 12.0 for Windows. Descriptive characteristics were presented as percentages for quantitative variables including measurement of thyroid hormones and ejection fraction. Mean and standard deviation were reported.Results:Diastolic parameters were markedly altered, mainly isovolumic relaxation time, which was increased and reduction of E/A wave ratio (1.Conclusions:Implication for echocardiography in SCH patients observed were that early recognition of silent diastolic dysfunction can be done. We can institute L-thyroxinee therapy which has been found to reverse diastolic dysfunction of heart along with improvement in lipid levels, decreased systemic vascular resistance, diastolic hypertension and coagulation profile. SCH, invariably affects heart and sooner or later and leads to diastolic dysfunction. Early recognition by echocardiography and then treatment with L-thyroxinee is indicated.

Effectiveness of home-based pulmonary rehabilitation:systematic review and meta-analysis

INTRODUCTION: Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. METHODS AND ANALYSIS: Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. RESULTS: We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32–1.44; p=0.002) and HRQoL (SMD −0.62, 95% CI −0.88–−0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD −0.10, 95% CI −0.25–0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI −0.15–0.17; p=0.87). CONCLUSION: Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation

Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases:a systematic review protocol

INTRODUCTION: Chronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care. METHODS AND ANALYSIS: We will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for ‘Chronic Respiratory Disease’ AND ‘Pulmonary Rehabilitation’ AND ‘Home-PR’, and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR? ETHICS AND DISSEMINATION: Research ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences. PROSPERO REGISTRATION NUMBER: CRD42020220137