EFFECT OF LIFESTYLE AND DIETARY MODIFICATIONS ON PREHYPERTENSIVE CASES OF LOWER SOCIOECONOMIC POPULATION IN AHMEDABAD CITY

  Background: Prehypertension is associated with high blood pressure and higher cardiovascular risk, and it should be suggested to prehypertensive patients that they modify their lifestyle in order to help avoid these problems. Methodology: The present study was the cross-sectional longitudinal study conducted on prehypertensive subjects of lower socio-economic group residing in Ahmedabad City. The participants were explained regarding modification in form of avoidance of entire amount of salt, morning exercise in form of brisk walking for half an hour at least three times a week and abstinence of smoking and alcohol in subjects who are habituated. Patients were instructed to attend OPD for every one month in the morning for 3 months as follow up. Results: In our study, pre HTN was detected in 72 (40%) of male subjects and 70 (41.1%) of female subjects. Prehypertension was found to be more prevalent in males (54.6%) as compared to females (45.4%). Overall 81.15% of subjects who were prehypertensive were reverted to normotension within 3 months with life style modification. Conclusion: It is concluded from our study that preHTN is quite prevalent affecting > 40% of urban population of lower socioeconomic class. Weight reduction, abstinence from smoking, regular exercise and salt reduction are highly effective, easy to follow and cheaper measures to control pre HTN and prevent its progression to hypertensive levels thereby also reducing cardiovascular and other complications of HTN

PROPORTION OF PULMONARY KOCHS IN EXTRAPULMONARY TUBERCULOSIS: A CROSS SECTIONAL STUDY IN AHMEDABAD CITY

Background: It is a very common experience of many physicians that a good number of extrapulmonary tuberculosis patients are suffering from asymptomatic pulmonary koch’s and many times it is diagnosed as a chance finding by chest X ray during routine investigation for general health check up or assessment for fitness purpose. Methodology: The present study was the cross-sectional study conducted on the randomly selected cases of extrapulmonary tuberculosis. A pre-designed semi-structured questionnaire was used to find out the presence of respiratory signs suggestive of symptomatic or asymptomatic pulmonary tuberculosis. In all participants, chest X ray, sputum for Acid Fast Bacilli (AFB), Complete Blood Count (CBC), ESR was done to find out or support pulmonary tuberculosis pathology. Results: Out of 140 patients of extrapulmonary tuberculosis 39.3% had pleural effusion, while almost similar number had abdominal Koch’s (37.9%) in the form of ileo-caecal Koch’s, mesenteric and para-aortic lymph nodes enlargement and tuberculous ascites. Pulmonary Koch’s was found out in 20 patients i.e. 14.3% of patients. Conclusion: Profile of pulmonary pathology in extrapulmonary tuberculosis is not very high. We found only a small proportion (14.3%) of patients having associated pulmonary Koch’s that too was asymptomatic in majority (65%).Tuberculous pleural effusion and intestinal koch’s are the two commonest forms of extrapulmonary involvement

Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Background Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. Methods We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602. Findings Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1·34 years [IQR 0·19–2·44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1·35 (95% CI 1·20–1·50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2·45 (1·82–3·29) for intracranial haemorrhage and 1·23 (1·08–1·40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4·55 [95% CI 3·08–6·72] for intracranial haemorrhage vs 1·47 [1·19–1·80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5·52 [3·36–9·05] vs 1·43 [1·07–1·91]; and for ≥20 cerebral microbleeds, aHR 8·61 [4·69–15·81] vs 1·86 [1·23–2·82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48–84] per 1000 patient-years vs 27 intracranial haemorrhages [17–41] per 1000 patient-years; and for ≥20 cerebral microbleeds, 73 ischaemic strokes [46–108] per 1000 patient-years vs 39 intracranial haemorrhages [21–67] per 1000 patient-years). Interpretation In patients with recent ischaemic stroke or transient ischaemic attack, cerebral microbleeds are associated with a greater relative hazard (aHR) for subsequent intracranial haemorrhage than for ischaemic stroke, but the absolute risk of ischaemic stroke is higher than that of intracranial haemorrhage, regardless of cerebral microbleed presence, antomical distribution, or burden

Analysis of Outcomes in Ischemic vs Nonischemic Cardiomyopathy in Patients With Atrial Fibrillation A Report From the GARFIELD-AF Registry

IMPORTANCE Congestive heart failure (CHF) is commonly associated with nonvalvular atrial fibrillation (AF), and their combination may affect treatment strategies and outcomes