Hypertension & pre-hypertension in developing countries

Hypertension is reported to be the fourth contributor to premature death in developed countries and the seventh in developing countries1. Recent reports indicate that nearly 1 billion adults (more than a quarter of the world’s population) had hypertension in 2000, and this is predicted to increase to 1.56 billion by 20252. Earlier reports also suggest that the prevalence of hypertension is rapidly increasing in developing countries3,4 and is one of the leading causes of death and disability in developing countries

QUALITATIVE AND QUANTITATIVE PHYTOCHEMICAL ANALYSIS AND BACTERICIDAL ACTIVITY OF PELARGONIUM GRAVEOLENS L'HER

Objective: The present study investigates the qualitative and quantitative phytoconstituents and bactericidal effect of medicinally important Pelargonium graveolens L' Her leaves extracts. Methods: Preliminary phytochemical screening analyses were determined using standard protocol methods. In addition, antibacterial activities of the P. graveolens leaves extracts were evaluated by disc diffusion method against Gram-positive and Gram-negative bacteria. Results: The results revealed that ethanolic extract of P. graveolens was found to be the predominant occurrence of phytochemicals (9/11) which contains flavonoid, phenol, tannins, saponins, reducing sugar, glycosides, terpenoids, anthraquinone, and phlorotannins while starch and steroids were absent. In quantitative estimation of bioactive phytoconstituents showed carbohydrates (74 mg/gdw), protein (41.25 mg/gdw), chlorophyll (2.2±0.05 mg/gdw), lipids (0.07 mg/gdw), tannins (135.3 gm/gdw), phenolic compounds (123.75 mg/gdw) and flavonoids (50 mg/gdw) were found to have higher amount in ethanolic extract followed by acetone, methanol and aqueous extract and also showed an inhibitory action on growth of tested bacteria. Conclusion: Ethanolic extract of the P. graveolens leaves hold promises as a potential source of pharmaceutically important phytochemicals and also have strong antibacterial activity against Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa and Klebsiella pneumonia. Keywords: Phytochemical screening, Primary and secondary metabolites, Antibacterial screening, Pelargonium graveolen

Evidence for benefits from diabetes Education Program

Comprehensive patient education is required to provide the patient with the self management skills necessary to achieve good glycemic control. In order to convey the importance of patient education, the American Diabetes Association (ADA) has labeled self-management education as the corner stone therapy for the patient with diabetes. Previous research has shown that patient education adds value to diabetes management and that specific interventions aimed at improving patient knowledge can improve diabetes control. Many patients who have had diabetes for several years do not know exactly how diabetes affects the foot. Patients with less formal education have less knowledge of diabetes and this is usually more common in women. When patients are evaluated on their knowledge about diabetes, those who attend education programs seem to have a better knowledge than the non-attenders. The value of patient education is evident from research demonstrating that patients who never received diabetes education are at increased risk of a major complication. The basic objectives in the handling of type-2 diabetes mellitus patients are reaching normal metabolic control and preventing complications. Intensive efforts to increase awareness among health professionals and diabetic individuals to improve diabetes management through education are urgently needed as it provides a useful benchmark to plan future strategies in diabetes care

Reliability and Validity of a Modified PHQ-9 Item Inventory (PHQ-12) as a Screening Instrument for Assessing Depression in Asian Indians (CURES - 65)

Abstract Objectives: To evaluate the validity and reliability of the modified Patient Health Questionnaire(PHQ) 12 item instrument as a screening tool for assessing depression compared to the PHQ -9 in a representative south Indian urban population. Methods: The Chennai Urban Rural Epidemiology Study [CURES] is a large cross-sectional study conducted in Chennai, South India. In Phase 1 of CURES(urban component), 26,001 individuals aged ≥ 20 years individuals were selected by a systematic sampling technique of whom one hundred subjects were randomly selected, using computer-generated numbers, for this validation study. Two self-reported questionnaires (modified PHQ-12 item and PHQ 9 item) were administered to the subjects to compare their effectiveness in detecting depression. Reliability and validity were assessed and Receiver Operating Characteristic (ROC) curves were plotted. Pearson’s correlation was used to compare the two questionnaires. Results: The mean age of the study was 38.6±11.6 years and 48% were males. Pearson’s correlation coefficient between the modified PHQ-12 and the PHQ-9 item was 0.913 [p<0.0001]. Factor Analysis revealed that the modified PHQ 12 item scale can be used as a unidimensional scale and had excellent internal consistency(Cronbach’s alpha:0.88). A cut point of >4 calculated using the ROC curves for the modified PHQ- 12 item had the highest sensitivity (92.0%) and specificity (90.7%) using PHQ-9 as the gold standard. The positive predictive value was 76.7%, and the negative predictive value, 97.1% and the area under the ROC curve, 0.979 (95% Confidence Interval: 0.929 - 0.997, p<0.0001). Conclusion: The modified PHQ-12 item is a valid and reliable instrument for large scale population based screening of depression in Asian Indians and a cut point score of 4 or greater gave the highest sensitivity and specificity.

Prevention Awareness Counselling and Evaluation (PACE) Diabetes Project: A Mega Multi-pronged Program for Diabetes Awareness and Prevention in South India (PACE - 5)

Objective: The Prevention Awareness Counselling Evaluation (PACE) Diabetes Project is a large scale community based project carried out to increase awareness of diabetes and its complications in Chennai city (population : 4.7 million) through 1) public education 2) media campaigns 3) general practitioner training 4) blood sugar screening and 5) community based “real life” prevention program Methods: Education took place in multiple forms and venues over the three-year period of the PACE project between 2004 - 2007. With the help of the community, awareness programs were conducted at residential sites, worksites, places of worship, public places and educational institutions through lectures, skits and street plays. Messages were also conveyed through popular local television and radio channels and print media. The General Practitioners (GPs) program included training in diabetes prevention, treatment and the advantages of early detection of complications. Free random capillary blood glucose testing was done for individuals who attended the awareness programs using glucose meter. Results: Over a three-year period, we conducted 774 education sessions, 675 of which were coupled with opportunistic blood glucose screening. A total of 76,645 individuals underwent blood glucose screening. We also set up 176 “PACE Diabetes Education Counters” across Chennai, which were regularly replenished with educational materials. In addition, we trained 232 general practitioners in diabetology prevention, treatment and screening for complications. Multiple television and radio shows were given and messages about diabetes sent as Short Message Service (SMS) through mobile phones. Overall, we estimate that we reached diabetes prevention messages to nearly two million people in Chennai through the PACE Diabetes Project, making it one of the largest diabetes awareness and prevention programs ever conducted in India. Conclusion: Mass awareness and screening programs are feasible and, through community empowerment, can help in prevention and control of non-commuincable diseases such as diabetes and its complications on a large scale

Diabetes-social and economic perspectives in the new Millenium

Prevalence of diabetes is increasing in pandemic proportions, particularly in developing countries like India. The recent reports from the World Health Organization rates India as the country with the largest number of diabetic subjects in the world. The Chennai Urban Population Study (CUPS), The Chennai Urban Rural Epidemiology Study (CURES) and the National Urban Diabetes Survey (NUDS) revealed rising prevalence of diabetes in India. Some of the significant risk factors associated with diabetes are similar worldwide, but their intensities vary between races, regions and countries. The reason for escalation of diabetes prevalence in India could be attributed to a combination of genetic factors and environmental factors due to urbanization and industrialization, which has led to sedentary lifestyle, physical inactivity, stress and obesity arising from energy and fat rich diets. The long-term complications of diabetes occurring during the most productive years of their lives create a devastating burden of morbidity and mortality, which poses an economic and social burden both at the individual and at the national level. Compared to non-diabetic individuals, diabetic individuals are more than twice as costly to treat, mainly due to the high costs related with management of associated complications. Prevention seems to be the need of the hour to tackle this epidemic. This article highlights the social and economic implications of diabetes in India and emphasis the measures required to prevent diabetes

Increased Awareness about Diabetes and Its Complications in a Whole City: Effectiveness of the “Prevention, Awareness, Counselling and Evaluation” [PACE] Diabetes Project [PACE-6]

Abstract Aims and Objectives : To determine the effectiveness of a large scale multipronged diabetes awareness program provided through community involvement in Chennai. Material and Methods: Mass awareness and free screening camps were conducted between 2004-2007 at various locations of Chennai as part of the Prevention, Awareness, Counselling and Evaluation [PACE] Diabetes Project. During a 3-year period, 774 diabetes awareness camps were conducted to reach the public directly. After the PACE project was completed, 3,000 individuals, representative of Chennai, were surveyed in 2007 using a systematic stratified random sampling technique. The results were compared to a similar survey carried out, as part of the Chennai Urban Rural Epidemiology Study [CURES] in 2001 - 2002, which served as a measure of baseline diabetes awareness. Results: Awareness of a condition called “diabetes” increased significantly from 75.5% in 2001-2002 (CURES) to 81% (p < 0.001) in 2007 (PACE). 74.1% of the citizens of Chennai are now aware that the prevalence of diabetes is increasing as compared to 60.2% earlier [p<0.001]. Significantly more people felt that diabetes could be prevented (p<0.001), and that a combination of diet and exercise were needed to do so (p<0.001). Respondents reporting obesity, family history of diabetes, hypertension and mental stress as risk factors increased significantly after PACE (p<0.001). More people were able to correctly identify the eyes (PACE 38.1% compared to CURES -16.1%, p < 0.001), kidney (PACE 42.3% compared to CURES 16.1%, p < 0.001), heart (PACE 4.6% compared to CURES 5.8%, p < 0.001) and feet (PACE 35.0% vs CURES 21.9%, p < 0.001) as the main organs affected by diabetes. Conclusion: Through direct public education and mass media campaigns, awareness about diabetes and its complications can be improved even in a whole city. If similar efforts are implemented state-wise and nationally, prevention and control of non-communicable diseases, specifically diabetes and cardiovascular disease, is an achievable goal in India.

The Chennai Urban Rural Epidemiology Study (CURES) - study design and methodology (Urban Component) (CURES - 1)

The report of World Health Organization (WHO) shows that India tops the world with the largest number of diabetic subjects. This increase is attributed to the rapid epidemiological transition accompanied by urbanization, which is occurring in India. There is very little data regarding the influence of affluence on the prevalence of diabetes and its complications particularly retinopathy in the Indian population. Furthermore, there are very few studies comparing the urban / rural prevalence of diabetes and its complications. The Chennai Urban Rural Epidemiology Study (CURES) is designed to answer the above questions. CURES is initially planned as a cross-sectional study to evolve later into a longitudinal study. Subjects for the urban component of the CURES have been recruited from within the corporation limits of Chennai City. Chennai (formerly Madras), the largest city in Southern India and the fourth largest in India has been divided into 10 zones and 155 wards. 46 wards were selected by a systematic random sampling method to represent the whole of Chennai. Twenty thousand and one individuals were recruited for the study, this number being derived based on a sample size calculation. The study has three phases. Phase one is a door to door survey which includes a questionnaire, anthropometric, fasting capillary blood glucose and blood pressure measurements. Phase two focussed on the prevalence of diabetic complications particularly retinopathy using standardized techniques like retinal photography etc. Diabetic subjects identified in phase one and age and sex matched non-diabetic subjects will participate in these studies. Phase three will include more detailed studies like clinical, biochemical and vascular studies on a sub-sample of the study subjects selected on a stratified basis from phase one. CURES is perhaps one of the largest systematic population based studies to be done in India in the field of diabetes and its complications like retinopathy, nephropathy and neuropathy

Prevalence and Risk Factors of Diabetic Nephropathy in an Urban South Indian Population: The Chennai Urban Rural Epidemiology Study (CURES 45)

OBJECTIVE— The aim of this study was to determine the prevalence of diabetic nephropathy among urban Asian-Indian type 2 diabetic subjects. RESEARCH DESIGN AND METHODS— Type 2 diabetic subjects (n 1,716), inclusive of known diabetic subjects (KD subjects) (1,363 of 1,529; response rate 89.1%) and randomly selected newly diagnosed diabetic subjects (NDD subjects) (n 353) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Microalbuminuria was estimated by immunoturbidometric assay and diagnosed if albumin excretion was between 30 and 299 g/mg of creatinine, and overt nephropathy was diagnosed if albumin excretion was 300 g/mg of creatinine in the presence of diabetic retinopathy, which was assessed by stereoscopic retinal color photography. RESULTS— The prevalence of overt nephropathy was 2.2% (95% CI 1.51–2.91). Microalbuminuria was present in 26.9% (24.8 –28.9). Compared with the NDD subjects, KD subjects had greater prevalence rates of both microalbuminuria with retinopathy and overt nephropathy (8.4 vs. 1.4%, P 0.001; and 2.6 vs. 0.8%, P 0.043, respectively). Logistic regression analysis showed that A1C (odds ratio 1.325 [95% CI 1.256 –1.399], P 0.001), smoking (odds ratio 1.464, P0.011), duration of diabetes (1.023, P0.046), systolic blood pressure (1.020, P 0.001), and diastolic blood pressure (1.016, P0.022) were associated with microalbuminuria. A1C (1.483, P 0.0001), duration of diabetes (1.073, P 0.003), and systolic blood pressure (1.031, P 0.004) were associated with overt nephropathy. CONCLUSIONS— The results of the study suggest that in urban Asian Indians, the prevalence of overt nephropathy and microalbuminuria was 2.2 and 26.9%, respectively. Duration of diabetes, A1C, and systolic blood pressure were the common risk factors for overt nephropathy and microalbuminuria