The impact of non-steroidal anti-inflammatory drugs use in elderly cardiovascular patients: an observational study from tertiary care in South India

Background: Long-term use of NSAIDs, by patients having cardiovascular conditions, has shown to increase the risk of cardiovascular events and increased risk of death. Hence, the study was conducted to determine the complications related to NSAID use by the elderly patients with cardiovascular disease (CVD).Methods: The study was a single-center prospective observational study conducted November 2017 to October 2018. Elderly patients (>60 years) suffering from various CVDs and reported NSAID intake daily for at least one month were included. A questionnaire included demographic, treatment related history and complete details of NSAIDs intake including nature, dose, indication, source etc. The same questionnaire was again filled at the end of one-year follow-up.Results: A total of 100 participants were included in the study. The mean age was 72±8.6 years. Majority of the patients (93%) had hypertension, and 69% of the patient had previous MI.  Five NSAIDs (diclofenac, ibuprofen, mefenamic acid, naproxen, and ketorolac) were used routinely. At least one over the counter NSAID used was reported by 86%, 57% were prescribed at least one NSAIDs by their orthopaedics and physicians. At the end of 1-year follow-up, authors found that 71% had MI (2% increase), 4% developed reinfarction, 20% had severe left ventricular failure (4% increase), 7% had atrial fibrillation (1% increase), and 2% patients died and 63% patients reported raise in systolic blood pressure by 5mmHg.Conclusions: High prevalence of concomitant NSAID use among elderly CVD patients, which might be contributing towards increase in CVS morbidity and mortality

Technological Need Assessment and Capacity Building of Farm Women in Livestock Rearing

It has been reflected that women farmers are engaged in the livestock rearing for additional income generation for their family. They provide 60 percent of the livestock farming labour. Contribution of woman folk in dairy production system, like in all other land-related activities, is enormous. She harvests fodder-yielding crops and gather fodder and bedding material from the forest areas, make hay and stack it, feed and look after the animals, cleans animal shed, milks the animal, processes and markets the milk, and does almost everything relating to smallholder dairy farming. Men’s role in dairy is limited. He participates only in the marketing of milk, looking after grazing and sick animals, and in providing service to dairy animals. Although much of work of livestock farming is carried out by women, they have very limited knowledge about new technologies which can enhance their knowledge, skills, practices and income. Most of extension programme are designed and implemented with an assumption that all farm managers and decision makers are men. Although the contribution of women farmer is higher in livestock rearing but with traditional practices and poor knowledge base, they are not able to manage their animals properly. Hence, the present study has been initiated with the following objectives: To explore the technological needs of women farmers related to livestock rearing practices To organize capacity building programmes for empowering farm women in livestock rearing practices

AN APPROACH TO RISK MANAGEMENT FOR E-COMMERCE

Today’s trend of online shopping proves the vital role e-commerce plays in our daily life. Online transactions require reliable networks, and reliable networks depend on secure information technology. These networks have many advantages, but they have disadvantages as well—notably, the need for risk management. The growing importance of e-commerce, with its associated need to ensure trust in online transactions, has led the authors to study and propose risk management in e-commerce from a holistic perspective, thus enabling the implementation of real-time auditing of e-commerce transactions using the digital agents’ technology. In this paper, the authors discuss e-commerce’s risks and present a methodology that can be used to manage those risks. It concludes that e-commerce risks are a high priority for online businesses, and that many of the requisite controls are extensions of controls for managing risk in other information systems

Purple urine bag syndrome- changing hue!

Purple Urine Bag Syndrome (PUBS) is a unique disease entity characterised by purple discoloration of urine secondary to recurrent urinary tract infections with indigo and indirubin producing bacteria and is predominantly seen in constipated, chronically debilitated and catheterised women with alkaline urine. This syndrome indicates underlying recurrent urinary tract infections (UTIs) associated with higher incidence of mortality and morbidity than urinary tract infection alone without this occurrence. This article is about an elderly hypothyroid woman with PUBS and reviews the need to be aware of this entity

Study of anaemia in type 2 diabetes mellitus and its correlation with albuminuria and eGFR

Background: Diabetes mellitus (DM) is a common metabolic disease. Anaemia is a common accompaniment to diabetes, particularly in patients with albuminuria or reduced renal function. Anaemia is more frequent and more severe at any level of glomerular filtration rate (GFR) in diabetics compared to nondiabetic patients. Methods: One hundred patients with type 2 diabetes mellitus were included in the study. Complete blood count, serum iron profile, ferritin, vitamin B12 and folate, kidney function tests and urine albumin creatinine ratio were assessed for these patients. Estimated glomerular filtration rate (eGFR) was calculated with MDRD-4 variable formula. Results: Fifty-four patients (54%) were found to be anaemic.  Serum ferritin <50 µg/l was taken as cut off for defining iron deficiency anaemia. 21 patients had iron deficiency anaemia (IDA) and 33 had anaemia of chronic disease (ACD). Serum vitamin B12 and folate levels were within normal limits in all the patients. There was a rise in the prevalence of anaemia from 25.9% in patients with a normal ACR to 59.2% in those with microalbuminuria and to 75% in macroalbuminuria. Conclusions: Any degree of renal impairment and albuminuria are the risk factors for anaemia in these patients. Hence screening, characterization and treatment of aneamia in type 2 DM may be helpful in management of these patients

Safety and effectiveness of intravenous iron sucrose versus standard oral iron therapy in pregnant women with moderate anaemia in India

Background: Aim of the study was to diagnose and treat pregnant females with iron deficiency anaemia, to reduce the complications associated with anaemia in pregnancy and to compare the efficacy, safety and side effects of iron sucrose with ferrous sulphate in the treatment of iron deficiency anaemia in pregnancy. Methods: The subjects for study were enrolled on fulfilling the inclusion and exclusion criteria. After detailed history, examination and investigations of patient the dose of intravenous iron sucrose was calculated by using the following formula: dose of iron: 2.4 x Hb deficit (11-patient’s actual Hb) x body weight in kg + 500. The following investigations were done on day 1: (a) complete blood count (CBC)- Hb, MCV, MCH, MCHC and PCV; (b) urine examination. Patients was randomly allocated into two groups. Group-A: oral group- containing 150 pregnant females. Group-B: intravenous group- containing 150 pregnant females. Results: Majority of women (48%) were from lower middle class and lower class (30%). Only 5.3% were from higher socioeconomic class (p value 0.0001). Maximum women (60%) were primigravida and 40% were multigravida. which indicates that most ladies enter pregnancy with poor iron reserves. Improvement in the mean haemoglobin levels after 4 weeks of treatment was statistically significant in both the groups (p value 0.0001). Similarly rise in the mean PCV levels after 4 weeks of the treatment was significantly associated in both the groups (p value 0.0001). There was slight rise in the mean MCV and MCH after 4 weeks. Peripheral blood film had changed from microcytic hypochromic to normocytic normochromic after 4 weeks of the treatment in both the group (p value 0.004). Presence of side effects with the oral and parenteral treatment were 81.3% and 12% respectively (p value 0.0001). Conclusions: From our study, it can be concluded that intravenous iron sucrose has lesser side effects along with better absorption

Clinical study of neurological presentation of diabetes mellitus in a tertiary care hospital

Background: A wide range of commotions affecting the central and peripheral nervous systems, either directly or indirectly, may be observed in patients with diabetes mellitus. The spectrum of neurological complications among diabetes are quite varied.Methods: Authors conducted a Cross-sectional prospective observational study to study different neurological manifestations of diabetes mellitus. at NRI General Hospital, Chinakakani, Guntur District, Andhra Pradesh. The selected patients were studied in detail with history and physical examination. The investigations included Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), Glycosylated Hemoglobin (HbA1C).Results: A total of 100 subjects were included in the final analysis. Majority of participants were aged between 46 to 65 years, and 55% of them were males. Only 13% of the participants had HBA1c value below 7.5 gm%. Out of 100 participants, 82% participants had diabetic peripheral neuropathy. A total of 6 subjects had cranial neuropathy, with 5% participants having 3rd nerve and one participant had 6th nerve. Involuntary movements (Chorea) was present in 4% of patients. Among the people with Seizures, 6% participants had Hyperglycemic, and 2% participants had Hypoglycemic seizures. Out of 100 participants, 7 participants had dysautonomia.Conclusions: Peripheral neuropathy was the most common neurological manifestation among the diabetic population. The other key neurological abnormalities include cranial nerve palsy, dysautonomia, seizures and Chorea. Clinicians need to be aware the entire spectrum of neurological abnormalities among patients with type 2 Diabetes