Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

Objective To examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal. Design This study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured. Setting Nepal. Participants Adult patients with hypertension. Results Among 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=−0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces. Conclusions Undiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden

Correlation between red cell distribution width and coronary artery disease in patients undergoing elective coronary angiography

Background: Coronary artery disease (CAD) is the primary cause of death in developed countries and is one of the leading causes of disease burden in developing countries. Methods: This descriptive cross-sectional study included 124 purposively selected patients who underwent elective CAG in the department of cardiology, Chittagong medical college hospital, Chattogram, from July 2020 to June 2021. SPSS 23.0 software was used for processing and analysis at the end of the data collection period. Results: According to the Gensini score, patients were categorized into two groups (score <30 and ≥30). There were no significant differences between the two groups concerning BMI, smoking, hypertension, DM, F/H of CAD, statin or beta-blocker use, or the levels of hemoglobin, hematocrit, MCV, MCH MCHC, and creatinine. However, the mean age was older, and there were more males in the severe CAD group. The percentage of dyslipidemia was significantly higher in patients with Gensini score ≥30 than in patients with <30. RDW (OR: 2.629; 95% CI: 1.425-4.484; p=0.002) and age (OR: 1.058; 95%CI: 1.00-1.111; p=0.027) were independently correlated with the severity of CAD. The AUROC for red cell distribution width (RDW) was 0.915 with a p<0.001 for predicting CAD on CAG. It indicated a statistically significant association of RDW with the presence of CAD.  A cut-off value of 13.65% RDW had a sensitivity of 80% and specificity of 84.2% for the prediction of CAD. There were no significant differences between patients with and without angiographic CAD for BMI, hypertension, DM, statin, or beta-blocker use, or of the levels of hemoglobin, hematocrit, MCV, MCH, MCHC, and creatinine. However, the mean age was older, and there were more males in the CAD group. The percentage with dyslipidemia, smoking, and F/H of CAD was significantly higher in patients with CAD than in patients without CAD. The data indicate that only RDW was independently correlated with the presence of CAD (OR: 2.593; 95% CI: 1.347-4.989; p=0.004). Conclusions: RDW is associated with the presence of CAD and suggests that it might be a readily available test for predicting coronary artery diseases

Prevalence, antibiotic susceptibility profiles and ESBL production in Klebsiella pneumoniae and Klebsiella oxytoca among hospitalized patients

Background and Purpose: Klebsiella pneumoniae and Klebsiella oxytoca are the two most common pathogens causing nosocomial infections in humans and are of great concern for developing multidrug resistance. In the present study, K. pneumoniae and K. oxytoca from clinical samples were evaluated for their antibiotic sensitivity patterns against commonly used antibiotics and production of extended-spectrum beta-lactamase (ESBL). Materials and Methods: The isolates were obtained from tracheal swabs, sputum, wound swabs, pus, blood and urine samples of hospitalized patients. Klebsiella pneumoniae and Klebsiella oxytoca were identified by cultural and biochemical methods. Antibiotic sensitivity test was performed by modified Kirby-Bauer disc diffusion technique. ESBL production in Klebsiella spp. was confirmed by double disc synergy test. Results and Conclusion: Out of 500 clinical isolates, 120 were found positive for Klebsiella among which 108 were K. pneumoniae and 12 were K. oxytoca based on indole test. Prevalence rate of Klebsiella was found more prominent in males aged over 50 years, mostly in urine samples. Overall resistance pattern of Klebsiella isolates to Ampicillin, Amoxicillin, Ceftriaxone, Ciprofloxacin, Co-trimoxazole, Gentamicin, Nalidixic acid, Tetracycline was 100%, 90%, 45%, 40%, 45%, 25%, 50%, 35% respectively. Multidrug resistance was found more common in K. pneumoniae (56%) than in K. oxytoca (50%). Prevalence rate of ESBL producing Klebsiella was found 45% among which K. pneumoniae (50%) were found more prominent than K. oxytoca (25%). All the ESBL producing Klebsiella isolates were found to be multidrug resistant, showing 100% resistance to Ampicillin, Amoxicillin, Ceftriaxone and Ciprofloxacin

Relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients

Background: Hypertension stands as a widely recognized significant risk factor for cardiovascular disease. In clinical practice, it is advisable to measure blood pressure (BP) in both arms. The increasing attention on inter-arm blood pressure difference (IABPD) stems from its association with cardiovascular disease. This study aimed to assess the relationship between inter-arm blood pressure differences and predicted future cardiovascular risk in hypertensive patients. Methods: This cross-sectional study was conducted at the department of cardiology, Chittagong Medical College Hospital from July 2020 to June 2021. The study included 428 cases of previously or newly diagnosed hypertension, selected through convenient sampling. Data analysis was conducted using Microsoft Office tools and statistical package for the social sciences (SPSS) version 23.0. Results: In this study, 8.2% of patients exhibited noteworthy systolic IAD, and 2.3% demonstrated notable diastolic IAD. Median 10-year cardiovascular risk, assessed by Framingham and ASCVD calculators, was 21% and 11% respectively. A positive correlation was observed between sIAD and 10-year cardiovascular risk (p=0.003) and sIAD and 10-year ASCVD risk (p=0.041). Patients with significant sIAD had a higher incidence of ischemic heart disease compared to those without (p=0.041). Multiple regression analysis revealed a significant correlation between 10-year Framingham cardiovascular risk and sIAD (p=0.003). Conclusions: A significant difference in systolic blood pressure between arms is linked to a higher 10-year cardiovascular risk and the presence of cardiovascular disease in well-managed hypertensive patients. So, monitoring sIAD could be an additional factor in predicting future cardiovascular events in patients receiving hypertension treatment

Forecasting wholesale price of coarse rice in Bangladesh: A seasonal autoregressive integrated moving average approach

Abstract This article attempts to develop the model and to forecast the wholesale price of coarse rice in Bangladesh. Seasonal Autoregressive Integrated Moving Average (SARIMA) models have been developed on the monthly data collected from July 1975 to December 2011and validated using the data from December 2010 to December 2011. The results showed that the predicted values were consistent with the upturns and downturns of the observed series. The model with non seasonal autoregressive 1, difference 1 and moving average 1 and seasonal difference 1 and moving average 1 that is SARIM

Benefit incidence analysis of healthcare in Bangladesh – equity matters for universal health coverage

Background: Equity in access to and utilization of healthcare is an important goal for any health system and an essential prerequisite for achieving Universal Health Coverage for any country. Objectives: This study investigated the extent to which health benefits are distributed across socioeconomic groups; and how different types of providers contribute to inequity in health benefits of Bangladesh. Methodology: The distribution of health benefits across socioeconomic groups was estimated using concentration indices. Health benefits from three types of formal providers were analysed (public, private and NGO providers), separated into rural and urban populations. Decomposition of concentration indices into types of providers quantified the relative contribution of providers to the overall distribution of benefits across socioeconomic groups. Eventually, the distribution of benefits was compared to the distribution of healthcare need (proxied by ‘self-reported illness and symptoms’) across socioeconomic groups. Data from the latest Household Income and Expenditure Survey, 2010 and WHO-CHOICE were used. Results: An overall pro-rich distribution of healthcare benefits was observed (CI = 0.229, t-value = 9.50). Healthcare benefits from private providers (CI = 0.237, t-value = 9.44) largely favoured the richer socioeconomic groups. Little evidence of inequity in benefits was found in public (CI = 0.044, t-value = 2.98) and NGO (CI = 0.095, t-value = 0.54) providers. Private providers contributed by 95.9% to overall inequity. The poorest socioeconomic group with 21.8% of the need for healthcare received only 12.7% of the benefits, while the richest group with 18.0% of the need accounted for 32.8% of the health benefits. Conclusion: Overall healthcare benefits in Bangladesh were pro-rich, particularly because of health benefits from private providers. Public providers were observed to contribute relatively slightly to inequity. The poorest (richest) people with largest (least) need for healthcare actually received lower (higher) benefits. When working to achieve Universal Health Coverage in Bangladesh, particular consideration should be given to ensuring that private sector care is more equitable

Correlation of lipoprotein (a) level with severity of coronary lesion in coronary heart disease patients

Background: Cardiovascular diseases (CVDs) are the leading cause of death in developing nations, especially in low and middle-income countries (LMICs). Bangladesh has been undergoing an epidemiological transition from communicable to non-communicable diseases. This study aimed to investigate the association of risk factors with coronary heart disease (CHD) in patients from Bangladesh. Methods: This cross-sectional observational study was conducted in the department of cardiology, Chattogram Medical College and Hospital, Chattogram, Bangladesh from July 2018 to June 2019. A total of 100 patients were enrolled. Results: This cross-sectional study enrolled 100 CHD patients with a mean age of 53.21±10.29 years. The majority were obese (64, 64.0%), and hypertension was the most prevalent risk factor (77, 77.0%), followed by smoking (65, 65.0%) and dyslipidemia (58, 58.0%). Most patients had triple vessel disease (53, 53.0%), and significant CHD (81, 81.0%). Patients with severe CHD had higher levels of blood LDL-C, triglycerides, and Lp(a). Lp(a) levels, history of dyslipidemia, and LDL-C were independently associated with a Gensini score ≥20. These findings emphasize the independent association between Lp(a) and CHD severity, warranting greater attention to patients with elevated Lp(a) levels. Conclusions: This study suggested that Lp(a) is an independent risk factor for CHD in patients from Bangladesh. More attention should be paid to such patients with elevated Lp(a) level

Association between neutrophil to lymphocyte ratio with the severity of coronary artery diseases

Background: Coronary artery disease is a type of heart disease where the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. This study aimed to evaluate the association between neutrophil to lymphocyte ratio (NLR) with the severity of coronary artery diseases. Methods: This cross-sectional study was conducted in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram, Bangladesh during the period from 1 July 2020 to 31 June 2021. 160 patients undergoing elective coronary angiography with the symptoms of coronary artery disease were enrolled in this study. A purposive sampling technic was used. The association between NLR and Gensini score was assessed using Pearson’s or Spearman’s correlation analysis as appropriate. All data were processed, analyzed and disseminated by using MS Excel and SPSS version 23.0 program as per necessity. Results: The mean (±SD) Gensini score of our participants was 42.75 (±29.50) and the mean (±SD) NLR (Neutrophil-lymphocyte ratio) was 2.38 (±1.11). In this study, the AUROC for NLR was found as 0.851 with a P-value of <0.001, indicating a statistically significant association of NLR with the severity of CAD. The scatter dot diagram showed the correlation between NLR and Gensini score. Both the variables were positively correlated and the degree of correlation was found statistically significant (r=0.44; p<0.001) by Pearson’s correlation test. The multivariate logistic regression analysis showed that a high level of NLR had an independent association with severe CAD (with OR being 3.308) along with dyslipidemia. Conclusion: High blood NLR is associated with the severity of CAD and it may be useful for predicting angiographically severe disease

Association of serum uric acid level with angiographic severity of coronary artery disease: a study in a tertiary care hospital, Chittagong, Bangladesh

Background: Coronary artery disease (CAD) is a major global health issue. Serum uric acid (SUA), a byproduct of purine metabolism, is linked to CAD development and progression. Elevated SUA levels are an independent risk factor for cardiovascular mortality and may indicate endothelial dysfunction. The aim of the study was to the observed associate serum uric acid level with the angiographic severity of CAD. Methods: This observational study was conducted at Chittagong medical college hospital in Bangladesh from October 2020 to September 2021. It included 130 patients and used unpaired t-tests to analyze the association between serum uric acid level and angiographic severity of CAD patients. Ethical clearance was obtained from the institutional review board of Chittagong medical college and hospital. Results: A study of 130 patients found a significant relationship between serum uric acid (SUA) levels and CAD (CAD), vessel involvement, and CAD severity (p=0.001). Patients with CAD had higher SUA levels (mean 5.26±1.32 mg/dL) compared to those without CAD (mean 4.22±1.03 mg/dL). A SUA level range of 3.94-6.58 mg/dL was associated with CAD presence. Gender also showed a highly significant association with SUA levels (p=0.001), while age, BMI, and smoking status did not show significant differences. Conclusions: A strong positive association has been found between serum uric acid level and the severity of CAD. The findings of this study approve the effectiveness of hyperuricemia as an emerging risk factor for CAD