Comparison of risk profile in pre-menopausal and post-menopausal women with acute coronary syndrome

Background: The physiological changes associated with menopause are responsible for increase in cardiovascular disease after menopause. BMI, physical inactivity, metabolic syndrome, hypertension and diabetes mellitus increase in post-menopausal women which are all powerful predictors of cardiovascular events. The risk factor profile between pre-menopausal and post-menopausal women presenting with acute coronary syndrome was thus studied.Methods: This study was a prospective cross-sectional hospital based study and was conducted in the Department of Medicine and Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana wherein 50 pre-menopausal women and 50 post- menopausal women who presented with acute coronary syndrome were enrolled. The risk factor profile and angiography findings amongst the 2 groups were compared.Results: There was no difference in the incidence of Diabetes Mellitus and Hypertension among the pre & post-menopausal groups. The prevalence of family history of cardiovascular disease was higher in the pre-menopausal group. The post-menopausal women showed a significant decrease in physical activity due to sedentary lifestyle. Both the groups had high BMI and increased waist circumference. Lipid parameters did not show any significant difference between the two groups. However, pre-menopausal women had higher LDL-C and triglyceride levels and lower HDL-C levels. On analysis of the angiographic findings in diabetics and non-diabetics, of both the groups diabetes mellitus was much higher in subjects presenting with triple vessel disease suggesting extensive atherosclerosis.Conclusions: study showed physical inactivity as an important cardiovascular risk factor in post-menopausal women. Obesity is an important risk factor for coronary artery disease in both pre- and post-menopausal women

Risk factors for extubation failure in mechanically ventilated children in pediatric intensive care unit

Background: Mechanical ventilation is lifesaving in children with respiratory failure. However, its unnecessary prolongation once a child is capable of sustaining spontaneous effective ventilation is associated with significant complications. Objective: To identify the factors that lead to higher chance of extubation failure in mechanically ventilated children. Materials and Methods: A prospective, observational study was conducted over a period of 1 year. Children admitted to pediatric intensive care unit of a tertiary care hospital of Northern India aged 1 month–17 years, needing mechanical ventilation were included in the study. Predefined criteria were used to decide the timing of extubation. Relevant details were recorded to study various patient-related parameters and their association with extubation outcome. Results: Mean age of the study group was 50 months with a male:female ratio of 3:1. Extubation failure rate was 14.5%. Extubation failure was significantly higher in patients ventilated for >7 days (p=0.01), those with the pediatric risk of mortality score >10 at admission (p=0.009), in addition to peak inspiratory pressure >16 cm H2O (p=0.009) and FiO2 ≥0.35 (p=0.01) before extubation. Accidental extubation was also associated with higher extubation failure (p<0.001). Conclusion: Our study demonstrates that even though sicker patients requiring ventilation for longer duration are more prone to failed extubations, protocol based, and planned extubations lead to better extubation success

Clinical Profile and Outcome in Children of Dengue Hemorrhagic Fever in North India

Objective: The number of dengue fever (DF)/dengue hemorrhagic fever (DHF) cases reported in India has risen in recent years. This study was undertaken to evaluate clinical profile and outcome of children admitted with DHF/dengue shock syndrome (DSS), in the 2006 DHF epidemic in Ludhiana, Punjab. Methods: Eighty one children with dengue hemorrhagic fever were hospitalized in the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, India. All patients were diagnosed, managed and monitored according to a standard protocol. Findings: Children between 10-15 years were most commonly afflicted (59%). Infants were the least affected sub-group (3.7%). Ninety two percent of all children were of DHF and 8% cases presented in DSS. The common symptoms seen were fever (91%), vomiting (41%), poor intake (21%), abdominal pain (16%) and significant bleeding (15%). Hepatomegaly was present in 60% of cases. 85% of cases had petechiae alone, 15% had evidence of significant bleeding manifestation. Gastrointestinal bleeding was the commonest observed bleeding. The complications seen were liver dysfunction (14.8%), coagulopathy (3.7%), renal dysfunction (3.7%), and acute respiratory distress syndrome (2.4%) and disseminated intravascular coagulation (1.2%). Mortality in the study was 3.7%. Refractory shock and coagulopathy were seen in all cases with poor outcome. Conclusion: Increased awareness, better transport facilities and case management according to the WHO guidelines, is needed to further reduce mortality of DHF/DSS cases

Co-infection of Hepatitis A and E with Salmonella Infection; a Case Report

Background: Ours is a developing country so infectious diseases contribute maximum to the morbidity and mortality. Among these, water borne diseases like diarrhea, typhoid, infectious hepatitis etc. are on rise. Sometimes more than one type of infection coexists which makes the diagnosis and management a challenging task. We report a case of Coinfection of Salmonella typhi with Hepatitis A and E. Case Presentation: A 5 year old male child came to us with complaints of fever and jaundice for last 9 days. Blood culture of patient was positive for Salmonella typhi. Viral markers turned out to be positive for Hepatitis A and E. To the best of our knowledge coinfection of Hepatitis A and E with Salmonella has rarely been reported earlier. Conclusion: In view of the restricted finances in our country vaccines against typhoid and Hepatitis A can not be incorporated in the national immunization schedule at present but these vaccines can be offered on an individual basis

Pulmonary Functions in Normal School Children in the Age Group of 6-15 Years in North India

Objective: Lung function tests have become an integral part of assessment of pulmonary disease. As few studies on pulmonary function tests have been carried out in young children in India, the study was carried out in normal urban and rural school children in Ludhiana district of North India to determine pulmonary functions in the age group 6-15 years and to find its correlation with regards to age, sex, height and weight. Methods: The study group included 600 normal children between 6-15 years age from different urban and rural schools in the region. A preformed questionnaire was interviewed and detailed general physical and systemic examination was done. Pulmonary function tests were measured by using Micromedical Gold standard fully computerized portable auto spirometer (Superspiro Cat No. SU 6000). Findings: The present study shows, all the three independent variables (age, weight and height) have linear positive correlation with lung function parameters, both for boys and girls. Lung function values in boys were significantly higher as compared to that of girls. Urban children had higher lung function parameters than rural children except IRV, FEF25%. Among all anthropometric parameters, height was the most independent variable with maximum coefficient of correlation. Conclusion: Equations derived from the present study for estimation of the expected values of lung function will help to interpret the observed lung function values in children of North India