Heart attack encroaching fourth decade: autopsy study of western Maharashtra

Background: Indians are known to have the highest coronary artery disease (CAD) rates, and the conventional risk factors fail to explain this increased risk. At present, India has the highest burden of acute coronary syndrome and ST-elevation myocardial infarction (MI). Methods: An autopsy study of 6 years: January 2015 to December 2020 which included heart specimens affected by MI from medicolegal autopsies received in histopathology section. The received heart specimens were fixed in 10% formalin and processed as per routine histotechniques with H&E stain and slides prepared were studied under light microscopy. Results: Maximum number of myocardial infarction cases 21 (23.5%) were seen in the age group of 41-50. Commonest histopathological pattern noted was Healed myocardial infarction 38 (42.6%), followed by acute myocardial infarction (AMI) 29 (32.5%) then acute with healed myocardial infarction (AHMI) 22 (24.7%). Conclusions: Atherosclerosis being the most common cause of MI but frequency of non-atherosclerotic myocardial infarction is rising in 4th decade which is a matter of concern. The study of human atherosclerotic lesion is an extremely difficult task in a living subject and an autopsy study is the best possible way to work on it

Group Rekeying Protocol for Secure communication

Group communication is one of the approaches to impart the messages effectively. Yet, security is the issue for this, and thus keys are utilized to secure the information. In this paper, the key management in group communication, an advanced rekeying approach based on the Logical Key Hierarchy (LKH) and One way Function Tree (OFT) schemes are explained. The AES crypto scheme is used to rekey the keys and the performance of the approach is better than LKH and OFT. Forward and backward security is provided by the proposed rekeying scheme. It is a novel rekeying scheme for large-scale dynamic groups that levers on logical sub-grouping and join history. On contrary other schemes, subgroups only support efficient group key management, have no application meaning and are transparent to the application layer. It misuses the historical backdrop of joining events to build up an aggregate requesting among subgroups and among nodes in every subgroup, so as to effectively recoup from collusion attacks

Zeta Potential as a Diagnostic Tool to Determine the Angina Risk

Red blood cells (RBCs) moving in circulation are continuously exposed to the reactive oxygen species (ROS) that are circulating within the vascular system of body. The objective of the study is to determine the erythrocyte zeta potential and its morphological changes caused by oxidative stress in hypertensive patients in relation to the risk of development of cardiovascular disease (myocardial infarction). In this retrospective study, we investigated 186 samples, which include hypertension patients (n = 64), myocardial infarction patients (n = 52), treated myocardial infarction patients (n = 20), and normal healthy volunteers (n = 50). Morphological and electrochemical characteristics of RBCs in patients were analyzed using scanning electron microscopy and zeta potential study. These parameters were also statistically analyzed applying one way ANNOVA (Tukey’s comparison) using Graph Pad. Statistical analyses of data showed that Hypertensive (ZP-16.06 mV) and cardiac patients (ZP-9.94 mV) RBCs possessed significantly reduced zeta potential relative to that of RBCs from healthy individuals (ZP-23.39 mV) (P-value <0.0001). Microscopic imaging of Hypertensive RBCs revealed increased anisocytes and poikilocytes. These parameters were found exacerbated in patients suffering from Myocardial infarction. Hence, it can be concluded that ZP can be used as an effective diagnostic tool for detection of hypertension associated cardiovascular disorder risk

Students’ perspective on absenteeism: a cross-sectional study among students at government medical colleges of Western Maharashtra

Background: The professional courses as undergraduate medical education need high theoretical and clinical classes attendance as those students will be future doctors and will deal with the health and disease of the public. In spite of implementing strict policies regarding student attendance, the rate of absenteeism in medical colleges remains high and is a growing apprehension a phenomenon that is also on the rise in universities worldwide. Methods: A cross-sectional study in few Governments Medical Colleges of Western region of Maharashtra using a self-administered questionnaire. Data was collected and analysed through Google forms. Results: Preparatory leave before every examination required (50.7%), air-conditioned classrooms (49.7%), good ventilated classrooms (44.1%), interactive teachers (41.8%), decrease lecture duration (38%), more practical less theory classes (37.6%) and good transportation facilities (34.3%) were various major suggestions given by students to increase the overall attendance. Conclusions: Feedback from students must be repeatedly considered while designing and revising the curriculum to reduce absenteeism

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Hypertension, defined as persistently elevated systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools

Kilonova Luminosity Function Constraints Based on Zwicky Transient Facility Searches for 13 Neutron Star Merger Triggers during O3

We present a systematic search for optical counterparts to 13 gravitational wave (GW) triggers involving at least one neutron star during LIGO/Virgo's third observing run (O3). We searched binary neutron star (BNS) and neutron star black hole (NSBH) merger localizations with the Zwicky Transient Facility (ZTF) and undertook follow-up with the Global Relay of Observatories Watching Transients Happen (GROWTH) collaboration. The GW triggers had a median localization area of 4480 deg², a median distance of 267 Mpc, and false-alarm rates ranging from 1.5 to 10⁻²⁵ yr⁻¹. The ZTF coverage in the g and r bands had a median enclosed probability of 39%, median depth of 20.8 mag, and median time lag between merger and the start of observations of 1.5 hr. The O3 follow-up by the GROWTH team comprised 340 UltraViolet/Optical/InfraRed (UVOIR) photometric points, 64 OIR spectra, and three radio images using 17 different telescopes. We find no promising kilonovae (radioactivity-powered counterparts), and we show how to convert the upper limits to constrain the underlying kilonova luminosity function. Initially, we assume that all GW triggers are bona fide astrophysical events regardless of false-alarm rate and that kilonovae accompanying BNS and NSBH mergers are drawn from a common population; later, we relax these assumptions. Assuming that all kilonovae are at least as luminous as the discovery magnitude of GW170817 (−16.1 mag), we calculate that our joint probability of detecting zero kilonovae is only 4.2%. If we assume that all kilonovae are brighter than −16.6 mag (the extrapolated peak magnitude of GW170817) and fade at a rate of 1 mag day⁻¹ (similar to GW170817), the joint probability of zero detections is 7%. If we separate the NSBH and BNS populations based on the online classifications, the joint probability of zero detections, assuming all kilonovae are brighter than −16.6 mag, is 9.7% for NSBH and 7.9% for BNS mergers. Moreover, no more than 10⁻⁴, or φ > 30° to be consistent with our limits. We look forward to searches in the fourth GW observing run; even 17 neutron star mergers with only 50% coverage to a depth of −16 mag would constrain the maximum fraction of bright kilonovae to <25%

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework

Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension

Hypertension, defined as persistently elevated systolic blood pressure (SBP) &gt;140 mmHg and/or diastolic blood pressure (DBP) at least 90 mmHg (International Society of Hypertension guidelines), affects over 1.5 billion people worldwide. Hypertension is associated with increased risk of cardiovascular disease (CVD) events (e.g. coronary heart disease, heart failure and stroke) and death. An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels. We also discuss the relevance of specific approaches including consumption of sodium, potassium, sugar, fibre, coffee, tea, intermittent fasting as well as integrated strategies to implement these recommendations using, for example, behaviour change-related technologies and digital tools