Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men

Indo-Pakistani populations have one of the highest risks of coronary artery disease (CAD) in the world. A population-based, cross-sectional survey was conducted on 3143 adults aged ⩾40 years from 12 randomly selected communities in Karachi, Pakistan. Apart from smoking, women had more CAD risk factors (diabetes, hypertension, obesity, dyslipidaemia) than men. Definite CAD (history and Q waves on ECG) was more prevalent in men than in women (6.1% vs 4.0%; p = 0.009). In contrast, ischaemic and major ECG changes were twice as prevalent in women as in men (29.4% vs 15.6%, and 21.0% vs 10.5%; p<0.001 for each, respectively). All measures of CAD were strongly predicted by the metabolic syndrome, but that failed to account for the greater prevalence of ECG abnormalities in women than in men. The findings indicate that one in five middle-aged adults in urban Pakistan may have underlying CAD. Women are at greater risk than men

Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children

Background: Childhood obesity is an emerging global public health challenge. Evidence for the transition in nutrition in Indo-Asian developing countries is lacking. We conducted these analyses to determine the trends in nutritional status of school-aged children in urban Pakistan. Methods: Data on the nutritional status of children aged 5 to 14 years from two independent population-based representative surveys, the urban component of the National Health Survey of Pakistan (NHSP, 1990 - 1994) and the Karachi survey (2004 - 2005), were analysed. Using normative data from children in the United States as the reference, trends for age- and gender-standardised prevalence (95% CI) of underweight (more than 2 SD below the weight-for-age reference), stunted (more than 2 SD below the height-for-age reference) and overweight and obese (body mass index (BMI) 85(th) percentile or greater) children were compared for the two surveys. The association between physical activity and being overweight or obese was analysed in the Karachi survey using logistical regression analysis. Results: 2074 children were included in the urban NHSP and 1675 in the Karachi survey. The prevalence of underweight children was 29.7% versus 27.3% (p=0.12), stunting was 16.7% versus 14.3% (p=0.05), and prevalence of overweight and obese children was 3.0 versus 5.7 (p \u3c 0.001) in the NHSP and Karachi surveys, respectively. Physical activity was inversely correlated with being overweight or obese (odds ratio, 95% CI, 0.51, 0.32 - 0.80 for those who engaged in more than 30 minutes of physical activity versus those engaged in less than 30 minutes\u27 activity). Conclusions: Our study highlights the challenge faced by Pakistani school-aged children. There has been a rapid rise in the number of overweight and obsese children despite a persistently high burden of undernutrition. Focus on prevention of obesity in children must include strategies for promoting physical activity

Progressive Muscle Relaxation Using Video AIDS Reduces Blood Pressure of Hypertension Patients

Progressive muscle relaxation using video is used hypertensive patients to conduct movement activities to reduce stress. Therefore, the muscles of the body are relax. Hypertension or high blood pressure is still a serious threat that affects the productivity of a person's life in NTB. The study was intended to determine the effectiveness of progressive muscle relaxation using video aids to reduce blood pressure in hypertension patients. This research was conducted in the Work Area of Dasan Agung Public Health Center, Mataram City in May to September 2017. Quasi-experimental design of pre and post-test control group. The number of respondents was 60 people consisting of 30 controls and 30 interventions for sampling Random Sampling. Data analysis using T-test. &nbsp;The results showed there were differences of changing in blood pressure of respondents who were given progressive muscle relaxation using video aids compared to those who did not use. Conclusion Progressive muscle relaxation with video&nbsp;ads&nbsp;decreases blood pressure in hypertension patients compared to those who did not

A harmonic compensation strategy in a grid-connected photovoltaic system using zero-sequence control

Mitigation of harmonics for a grid-connected inverter is an important element to stabilize the control and the quality of current injected into the grid. This paper deals with the control method of a three-phase Grid-Connected Inverter (GCI) Photovoltaic (PV) system, which is based on the zero-sequence current adjuster. The proposed method is capable of removing the harmonic current and voltage without using any active and passive filters and without the knowledge of the microgrid topology and also impedances of distribution bands and loading conditions. This concept is adopted for the control of a Distributed Generator (DG) in the form of grid-connected inverter. The proposed control can be applied to the grid connected inverter of the PV. The fast dynamic response, simple design, stability, and fast transient response are the new main features of the proposed design. This paper also analyzes the circuit configuration effects on the grid connected inverter capability. The proposed control is used to demonstrate the improved stability and performance

Treatment of hypertension in rural Cambodia: results of a 6-year programme

This study was aimed to describe the outcomes of a hypertension treatment programme in two outpatient clinics in Cambodia. We determined proportions of patients who met the optimal targets for blood pressure (BP) control and assessed the evolution of mean systolic and diastolic BP (SBP/DBP) over time. Multivariate analyses were used to identify predictors of BP decrease and risk factors for LTFU. A total of 2858 patients were enrolled between March 2002 and June 2008 of whom 69.2% were female, 30.5% were aged >/=64years and 32.6% were diabetic. The median follow-up time was 600 days. By the end of 2008, 1642 (57.4%) were alive-in-care, 8 (0.3%) had died and 1208 (42.3%) were lost to follow-up. On admission, mean SBP and DBP were 162 and 94 mm Hg, respectively. Among the patients treated, a significant SBP reduction of 26.8 mm Hg (95% CI: 28.4-25.3) was observed at 6 months. Overall, 36.5% of patients reached the BP targets at 24 months. The number of young adults, non-overweight patients and non-diabetics reaching the BP targets was more. Older age (>64 years), uncontrolled DBP (>/=90 mm Hg) on last consultation and coming late for the last consultation were associated with LTFU, whereas non-diabetic patients were 1.5 times more likely to default than diabetics (95% CI: 1.3-1.7). Although the definite magnitude of the BP decrease due to antihypertension medication over time cannot be assessed definitely without a control group, our results suggest that BP reduction can be obtained with essential hypertension treatment in a large-scale programme in a resource-limited setting

Improved voltage unbalance and harmonics compensation control strategy for an isolated microgrid

This paper suggests an enhanced control scheme for a four-leg battery energy storage systems (BESS) under unbalanced and nonlinear load conditions operating in the isolated microgrid. Simplicity, tiny steady-state error, fast transient response, and low total harmonic distortion (THD) are the main advantages of the method. Firstly, a new decoupled per-phase model for the three-phase four-leg inverter is presented. It can eliminate the effect of power stage coupling on control design; thus, the three-phase four-leg power inverter can be viewed as three single input single output (SISO) control systems. Then, using an improved orthogonal signal generation method, the per-phase model of the four-leg inverter in the stationary and synchronous frame is derived. As the second step, a per-phase multi-loop control scheme for the four-leg inverter under unbalanced load conditions is suggested. The proposed control strategy has the ability to provide balanced output voltages under unbalanced load conditions by avoiding the need to deal with the symmetrical components. Finally, a multi-resonant harmonic compensator is used to actively prevent low-order harmonic currents to distort the output voltages of the three-phase four-leg grid-forming power converter. Simulations results are also presented to verify the performance of the suggested control strategy

Fuzzy Analytic Hierarchy Process (FAHP) Integrations for Decision Making Purposes: A Review

Fuzzy Analytic Hierarchy Process (FAHP) is generally used as decision making purpose. However, AHP provides a single numerical number. As the method can only yield binary decisions of either “yes” or “no”, the method is not compatible when the decision has uncertainties. Consequently, previous researchers have fused AHP with fuzzy to process alternatives with uncertainty judgment. In this paper, fundamental knowledge of separate tool was reviewed. Fundamental of both fuzzy and AHP were also  summarized in this article. The next phase of this paper was to split the types of FAHP namely to determine the relative weight and the rank or score. Two methods were utilized under FAHP to determine relative weight ; triangular and trapezoidal FAHP. Next type of FAHP was to determine the score of each alternative often carried out after triangular or trapezoidal FAHP. The second types of FAHP were Fuzzy TOPSIS, and VIKOR. These FAHPs were explained and steps to carry out were presented in this paper. In conclusion, all types of FAHP are compared in terms of computational time, number of steps and level of difficulty

Spectrum of antihypertensive therapy in South Asians at a tertiary care hospital in Pakistan

<p>Abstract</p> <p>Background</p> <p>Despite available guidelines on hypertension (HTN), use of antihypertensives is variable. This study was designed to ascertain frequency of patients on monotherapy and > 1 antihypertensive therapy and also to ascertain proportion of patients on diuretic therapy.</p> <p>Methods</p> <p>It was a crossectional study conducted on 1191 adults(age > 18 yrs)hypertensive patients selected by computerized International Classification of Diseases -9-coordination and maintenance (ICD-9-CM) presenting to a tertiary care hospital in Pakistan. Data on demographics, comorbids, type of antihypertensive drug, number of antihypertensive drug and mean duration of antihypertensive drug was recorded over 1.5 year period (2008-09). Blood pressure was recorded on admission. Primary outcome was use of combination therapy and secondary outcome was use of diuretic therapy.</p> <p>Results</p> <p>A total of 1191 participants were included. Mean age(SD) was 62.55(12.47) years, 45.3%(540) were males. Diabetes was the most common comorbid; 46.3%(551). Approximately 85% of patients had controlled hypertension. On categorization of anti hypertensive use into 3 categories;41.2%(491) were on monotherapy,32.2%(384) were on 2 drug therapy,26.5%(316) were on ≥3 drug therapy. Among those who were on monotherapy for HTN;34%(167) were on calcium channel blockers,30.10%(148) were on beta blockers, 22.80%(112) were on Angiotensin converting enzyme (ACE) inhibitors,12%(59) were on diuretics and 2.20%(11) were on Angiotensin receptor blockers(ARB). Use of combination antihypertensive therapy was significantly high in patients with ischemic heart disease(IHD)(p < 0.001). Use of diuretics was in 31% (369) patients. Use of diuretics was significantly less in patients with comorbids of diabetes (p 0.02), Chronic kidney disease(CKD)(p 0.003), IHD (p 0.001) respectively</p> <p>Conclusion</p> <p>Most patients presenting to our tertiary care center were on combination therapy. Calcium channel blocker is the most common anti hypertensive drug used as monotherapy and betablockers are used as the most common antihypertensive in combination. Only a third of patients were on diuretic as an antihypertensive therapy.</p