A Clinical Audit on Management of Hypertension

Background : Hypertension is a major public health problem globally in both the developed and developing countries and it leads to cardiovascular diseases, stroke and kidney failure. The aim of this study was to identify the deficiency of management and to know the overall approach both by physician and cardiologist in daily routine OPD setting. Materials and methods : The patients’ mean age was 54.9±9.9years, 53.2% were male and 46.8% were female. In history taking important symptoms, family history and smoking history were poorly recorded (51.2%). Results : Of the hypertensive patients, 78.4% were well controlled (BP<140/90). Out of 80 patients, 44 patients needed combined treatment either at the beginning or during follow up. Hypertension preceded before the onset of many newly detected diabetic subjects in our series. About 70% did have LVH and notably ACS were noted in 7.5% cases. 8.3% were obese. TIA/Hypertensive encephalopathy/CVD were detected in 6.2% cases. CCR or eGFR measurement done in only <1% of subjects routinely when we noted renalinsufficiency in 14% and interestingly some were having erectile dysfunction. Conclusion : A significant number (20%) of patients discontinued their BP check. At OPD setting Framingham 10 year CVD risk evaluated in <1% cases only. Refractory or Secondary HTN is seen in only 2 cases. Chatt Maa Shi Hosp Med Coll J; Vol.18 (1); Jan 2019; Page 49-51

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“A STUDY OF MICROALBUMINURIA IN NON DIABETIC HYPERTENSIVE PATIENTS”

10.36106/ijar/6200318 ◽

2020 ◽

pp. 1-3

Author(s):

Anup Latne ◽

Prabhakar Jirvankar

Keyword(s):

Cardiovascular Risk ◽

Tertiary Care ◽

Public Health Problem ◽

Cross Sectional Study ◽

Low Grade ◽

Major Public Health Problem ◽

Sectional Study ◽

Tertiary Care Centre ◽

Cross Sectional ◽

Hypertensive Patients

Hypertension is a major public health problem all over the world. The incidence of hypertension is increasing year after year and the prevalence of hypertension is increasing day by day due to increased life expectancy and aging population and their sedentary lifestyle. Hypertension is known to cause microvascular changes and increased cardiovascular risk from it. Microalbuminuria possibly reflects a state of increased renal endothelial permeability and is an easily measured marker of rather diffuse endothelial dysfunction, low grade inflammation and vascular disease burden2. Microalbuminuria has been determined as an important prognostic indicator and has been reported to be associated with increased cardiovascular risk and progressive renal damage. Reliable data on the prevalence of microalbuminuria in the general population and its association with cardiovascular risk factors is limited. Till now, there is little data available regarding screening and early treatment of hypertensive patients with microalbuminuria, as in the case of microalbuminuric non diabetic subjects. With these perspective this cross sectional study of microalbuminuria in non-diabetic hypertensive patients was undertaken to study prevalence of microalbuminuria in Non Diabetic hypertensive patients. Objectives: To determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and to correlate the presence of microalbuminuria with the patients of different clinical profiles. Materials and Methods: This was observational, cross sectional study of Patients diagnosed with hypertension either admitted in ward or attending OPD of Medical College and Tertiary Care Centre. Urine microalbumin creatinine ratio was used for estimation of microalbuminuria. Conclusion: It was proved that microalbuminuria prevalence was directly proportional to the duration of hypertension, the stage of hypertension. Prevalence of microalbuminria was low in ACE inhibitor and ARB treated hypertensive patients.

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Justification and active guideline implementation for spine radiography referrals in primary care

Acta Radiologica ◽

10.1177/0284185116661879 ◽

2016 ◽

Vol 58 (5) ◽

pp. 586-592 ◽

Cited By ~ 11

Author(s):

Pirita Tahvonen ◽

Heljä Oikarinen ◽

Jaakko Niinimäki ◽

Esa Liukkonen ◽

Seija Mattila ◽

...

Keyword(s):

Primary Care ◽

Lumbar Spine ◽

Guideline Implementation ◽

Public Health Problem ◽

Further Education ◽

Major Public Health Problem ◽

Spine Radiography ◽

Cervical Spine Radiography ◽

Active Implementation

Background Spinal disorders are a major public health problem. Appropriate diagnostic imaging is an essential part in the management of back complaints. Nevertheless, inappropriate imaging increases population collective dose and health costs without improving outcome. Purpose To determine the effects of active implementation of referral guidelines on the number and justification of spine radiography in primary care in one city. Material and Methods Specified guidelines for spine radiography were distributed to referring practitioners altogether three times during the study period. Educational lectures were provided before the guidelines were taken into use. The guidelines were also made available via the intranet. The number of spine radiography referrals during similar 6-month periods in the year preceding the interventions and the following 2 years was analyzed. Justification of 448 spine radiographs was assessed similarly. Results After interventions, the total number of spine radiography examinations decreased by 48% (P < 0.001) and that of cervical spine radiography by 46% ( P < 0.001), thoracic spine by 53% ( P < 0.001), and lumbar spine by 47% ( P < 0.001). The results persisted after 1-year follow-up. Before interventions, 24% of the cervical, 46% of the thoracic, and 32% of the lumbar spine radiography referrals were justified. After interventions, only justification of lumbar spine radiography improved significantly, 64% being justified ( P = 0.005). Conclusion Spine radiography in primary care can be reduced significantly by active referral guideline implementation. The proportion of inappropriate radiography was unexpectedly high. Thus, further education and studies concerning the appropriate use of spinal radiography seems to be needed.

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Study of association and prognostic correlation of cardiac troponin I estimation in acute decompensated heart failure patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20205403 ◽

2020 ◽

Vol 8 (1) ◽

pp. 26

Author(s):

Sunil Kumar Tripathi ◽

Vikas A. Mishra ◽

Amit B. Kinare ◽

Vishwa Deepak Tripathi ◽

Ravi Shankar Sharma

Keyword(s):

Heart Failure ◽

Troponin I ◽

Acute Decompensated Heart Failure ◽

Public Health Problem ◽

Decompensated Heart Failure ◽

Major Public Health Problem ◽

Positive Group ◽

Medical College ◽

Follow Up Study

Background: Heart failure is a major public health problem since last few decades affecting significant number of people worldwide. Acute decompensated heart failure is a major cause of hospitalization in elderly people with a high mortality rate. Heterogeneity and non-specificity of symptoms makes diagnosis of heart failure by clinical presentation alone more challenging. Aim of current study was to investigate troponin biomarkers in diagnosis, prognosis and management of acute decompensated heart failure. Methods: Present study was a prospective observational study conducted on 100 patients at Department of Cardiology, Superspeciality hospital, NSCB medical college Jabalpur and Department of cardiology Superspeciality hospital, SS medical college Rewa from October 2019 to August 2020. Patients were investigated for clinical, echocardiographic parameters and NYHA classification. Cardiac functions were analyzed by color doppler echocardiography. Results: According to study findings, 65.2% of TnI positive patients were males whereas 34.8% were females. Mean age of TnI positive group was observed to be higher. Majority of troponin positive patients were in NYHA class IV. Recurrent hospitalization was observed more in TnI positive group. Logistic regression analysis depicted systolic blood pressure reduced significantly (p<0.001) on follow up study in TnI positive patients, FBS was significantly more in TnI positive patients (131.4+42.9 mg/dl) (p=0.049). LVID was significantly more in TnI positive patients (p=0.022). Reduction in EF was statistically significant (p=0.03) at the three months follow up study. Conclusions: A positive prognostic correlation was established between ADHF and troponin positivity, large prospective randomized trials are necessary to recommend quantitative troponin I determination in all patients of acute decompensated heart failure for prognosis and guiding therapy.

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Renal Function Evaluation of Hypertensive Patients by Renogram in a Teaching Hospital

Faridpur Medical College Journal ◽

10.3329/fmcj.v11i1.30871 ◽

2016 ◽

Vol 11 (1) ◽

pp. 11-14

Author(s):

Jayanta Kumar Saha ◽

ARM Saifuddin Ekram ◽

Mohammed Shahadat Hossain ◽

ATM Ataur Rahman ◽

Prodip Kumar Biswas ◽

...

Keyword(s):

Renal Function ◽

Renal Involvement ◽

Public Health Problem ◽

Function Evaluation ◽

Major Public Health Problem ◽

College Hospital ◽

Cross Sectional ◽

Female Ratio ◽

Hypertensive Patients ◽

Medical College

Arterial Hypertension is the most common cardiovascular disease and is a major public health problem in both developed and developing countries. The aim of the study was to assess renal involvement in hypertensive patient by renogram, which is not detected by conventional biochemical test. This was a cross sectional observational study. Consecutive 30 hypertensive patients admitted in the medicine wards from March, 2006 to April, 2007 in Rajshahi Medical College Hospital, Bangladesh were taken as case. Informed consent was taken from all the study patients or from their attendants. Detail history was taken from each patient or from their attendants' then clinical examination and relevant investigations were done. Emphasis was laid to find out renal involvement in long standing hypertensive patients by renogram. After initial selection; laboratory investigations like Urine for R/M/E, Blood Sugar 2ABF, S. Creatinine, USG of KUB, ECG and Hb% were done for every patients. All patients included in this study renogram were done. Majority of the patient (40%) were between the age of 41-50 years and Male: Female ratio was 3:2. Most of the patient lead a moderately active life (66.67%). Serum Creatinine was raised in 23.33% patient whereas renal parenchymal insufficiency evidenced by renogram was found in 50% case. In this study, we found that a significant number of cases (26.67%) having renal parenchymal insufficiency were not detected by S. Creatinine level, but detected by renogram. Renogram is superior to conventional biochemical renal function test for early detection of hypertensive nephropathy.Faridpur Med. Coll. J. Jan 2016;11(1): 11-14

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System Delay in Breast Cancer Diagnosis in Gaza Strip, Palestine

Journal of Oncology ◽

10.1155/2019/5690938 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Samira S. Abo Al-Shiekh ◽

Yasser S. Alajerami ◽

Bothyna B. Etewa ◽

Aymen M. Elsous

Keyword(s):

Breast Cancer ◽

Breast Imaging ◽

Gaza Strip ◽

Diagnostic Delay ◽

Public Health Problem ◽

Diagnostic Tools ◽

Major Public Health Problem ◽

Related Factors ◽

The Gaza Strip

Background. Breast cancer is a major public health problem and the first leading cause of cancer deaths among females in Palestine. Early diagnosis of breast cancer contributes to reduction of morbidity and mortality rates. This study aimed to explore system-related factors affecting the timely diagnosis of breast cancer in the Gaza Strip. Method and Materials. A mixed method, sequential explanatory design was employed. A quantitative study was conducted first, and it was cross-sectional in nature, followed by a qualitative study. An interviewed questionnaire and an abstraction sheet were used to collect necessary quantitative data among 122 females diagnosed with breast cancer. A purposive sample of five medical specialists were selected for in-depth interview. Descriptive and inferential analyses were used to find differences between variables. Odds ratio and confidence interval at 95% were presented, and P<0.05 was considered statistically significant. Results. Around 12.3% of women experienced diagnostic delay for 3 months and more, and 6.6% reported a delay in referral for more than 2 weeks. Regarding imaging delay, around 8.2% and 2.7% of women had reported a delay in performing mammography and ultrasound, respectively. Moreover, one-fourth reported delay in performing biopsy for more than 14 days, and 46.3% reported delay more than 14 days in getting histopathology report. In addition, 9% missed the follow-up after benign findings of the previous breast imaging and no national protocols are available for the diagnosis of breast cancer in the Gaza strip. Conclusion. There is a long appointment time for diagnostic tools especially in biopsy. The nonmalignant findings from mammography or ultrasound could affect diagnosis time. It is an urgent need to have a national protocol for diagnosis and management of breast cancer and to adopt screening, diagnostic, and follow-up programs under the supervision of the Ministry of Health.

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First-episode psychosis

Psychotic Disorders ◽

10.1093/med/9780190653279.003.0015 ◽

2020 ◽

pp. 122-131

Author(s):

Merete Nordentoft ◽

Nikolai Albert

Keyword(s):

Public Health Problem ◽

Convincing Evidence ◽

Community Treatment ◽

Psychotic Symptoms ◽

First Episode ◽

Major Public Health Problem ◽

Clinical Effects ◽

Long Run ◽

Follow Up Studies

Psychosis in the schizophrenia spectrum constitutes a major public health problem. There is convincing evidence for positive effects of 2-year specialized early intervention programs with intensive care, assertive outreach, and family involvement. Follow-up studies indicate a risk of loss of positive clinical effects after termination of specialized programs, but clinical effects can be sustained or even improved with prolonged specialized treatment or transfer to standard treatment, including assertive community treatment (ACT) for the most disabled patients. Long-term studies show substantial heterogeneity in clinical and functional outcomes, resulting in a very diverse picture. Ten-year follow-up studies of the OPUS and the AESOP cohort indicate that more than half of the patients will achieve stable remission of psychotic symptoms and that half of those patients can maintain remission in the long run without antipsychotic medication.

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Evaluation of Malignant Mesothelioma in Central Anatolia: A Study of 67 Cases

Canadian Respiratory Journal ◽

10.1155/2004/204793 ◽

2004 ◽

Vol 11 (4) ◽

pp. 287-290 ◽

Cited By ~ 11

Author(s):

Inci Gulmez ◽

Levent Kart ◽

Hakan Buyukoglan ◽

Ozlem Er ◽

Suleyman Balkanli ◽

...

Keyword(s):

Pleural Effusion ◽

Malignant Mesothelioma ◽

Environmental Control ◽

Public Health Problem ◽

Central Anatolia ◽

Major Public Health Problem ◽

Pleural Thickening ◽

Chest X Ray ◽

Fibrous Mineral

BACKROUND:Malignant mesothelioma (MM) is a fatal neoplasm which frequently results from exposure to asbestos or erionite.METHOD:Sixty-seven patients with MM were seen between 1990 and 2001. Their clinical and radiological features, as well as the therapy, were retrospectively evaluated.RESULTS:In 51 patients (76.1%), the MM was confined to the pleura, in 14 patients it was exclusively peritoneal and in two patients, it involved both areas. Of the 67 cases, 35 (52.2%) were women. The mean (± SD) age for all cases was 57.6±11.5 years. Dyspnea (67.2%), cough (55.2%) and chest pain (50.7%) were the most frequent symptoms of onset. Pleural effusion (92.4%) was the most common chest x-ray finding, whereas pleural effusion (60.8%), pleural nodules (34.7%) and pleural thickening (34.7%) were the most common computed tomography findings in pleural MM patients. The histological subtypes of MM were determined as epithelial in 60 patients (89.5%), sarcomatous in four patients (5.9%) and mixed in three patients (4.4%). Although 50.7% and 25.4% of the cases were exposed to erionite and asbestos, respectively, 23.9% of the cases recalled no exposure to asbestos or erionite. Exposures were environmental as opposed to occupational. Thirty-five patients (52.2%) were administered chemotherapy, and follow-up data were available for 22 patients. For these patients, the two-year survival rate was 22% and the two-year progression-free interval was 15.7%. There were no differences between patients with asbestos and erionite exposure.CONCLUSION:MM should be considered when exudative pleural effusion is detected in a patient who has been exposed to asbestos or erionite. MM is a major public health problem in parts of Turkey and compulsory environmental control of fibrous mineral should be considered.

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Esophageal Cancer and Treatment Modalities

10.33169/gsoaoj-i-101 ◽

2020 ◽

Vol I (1) ◽

pp. 1-3

Author(s):

Takalkar Unmesh Vidyadhar

Keyword(s):

Esophageal Cancer ◽

Public Health Problem ◽

Diagnostic Techniques ◽

Treatment Modalities ◽

Surgical Approaches ◽

Major Public Health Problem ◽

Minimally Invasive Surgical ◽

Predominant Type ◽

Modal Treatment

Esophageal cancer is eighth most common cancer worldwide with high biological aggressiveness and poor prognosis. Switching of predominant type from squamous cell carcinoma to adenocarcinoma in Western population, ethnic discrepancies and increased occurrences have identified it as major public health problem. Though monotherapy includes – surgery, radiotherapy and chemotherapy, optimal therapy for esophageal cancer is still debated. Treatment requires a multi-modal approach which includes chemotherapy, radiation therapy with or without surgical follow-up for most patients and chemoradiation for those with inoperable disease; endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection for Barrett’s esophagus/ early carcinoma patients and minimally invasive surgical approaches are standards for esophagectomy. Advancement in diagnostic techniques and the multi-modal treatment approach has led to an improvement in the overall survival of esophageal cancer patients.

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Newborn Screening for Sickle Cell Disease: Indian Experience

International Journal of Neonatal Screening ◽

10.3390/ijns4040031 ◽

2018 ◽

Vol 4 (4) ◽

pp. 31 ◽

Cited By ~ 1

Author(s):

Roshan Colah ◽

Pallavi Mehta ◽

Malay Mukherjee

Keyword(s):

Sickle Cell Disease ◽

Newborn Screening ◽

Sickle Cell ◽

Screening Program ◽

Clinical Manifestations ◽

Public Health Problem ◽

Major Public Health Problem ◽

Cell Disease ◽

Screening Programs

Sickle cell disease (SCD) is a major public health problem in India with the highest prevalence amongst the tribal and some non-tribal ethnic groups. The clinical manifestations are extremely variable ranging from a severe to mild or asymptomatic condition. Early diagnosis and providing care is critical in SCD because of the possibility of lethal complications in early infancy in pre-symptomatic children. Since 2010, neonatal screening programs for SCD have been initiated in a few states of India. A total of 18,003 babies have been screened by automated HPLC using either cord blood samples or heel prick dried blood spots and 2944 and 300 babies were diagnosed as sickle cell carriers and SCD respectively. A follow up of the SCD babies showed considerable variation in the clinical presentation in different population groups, the disease being more severe among non-tribal babies. Around 30% of babies developed serious complications within the first 2 to 2.6 years of life. These pilot studies have demonstrated the feasibility of undertaking newborn screening programs for SCD even in rural areas. A longer follow up of these babies is required and it is important to establish a national newborn screening program for SCD in all of the states where the frequency of the sickle cell gene is very high followed by the development of comprehensive care centers along with counselling and treatment facilities. This comprehensive data will ultimately help us to understand the natural history of SCD in India and also help the Government to formulate strategies for the management and prevention of sickle cell disease in India.

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Dietary Adherence of Saudi Males to the Saudi Dietary Guidelines and Its Relation to Cardiovascular Diseases: A Preliminary Cross-Sectional Study

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd6020017 ◽

2019 ◽

Vol 6 (2) ◽

pp. 17 ◽

Cited By ~ 3

Author(s):

Areej Alkhaldy ◽

Reem Alamri ◽

Rozana Magadmi ◽

Nrvana Elshini ◽

Rania Hussein ◽

...

Keyword(s):

Cardiovascular Disease ◽

Dietary Intake ◽

Fasting Blood Glucose ◽

Public Health Problem ◽

Dietary Guidelines ◽

Dietary Adherence ◽

Major Public Health Problem ◽

Cvd Risk ◽

Cross Sectional ◽

Adherence Score

Cardiovascular disease (CVD) is a major public health problem in Saudi Arabia. Dietary intake plays a major role in CVD incidence; however, the dietary intake status in Saudi nationals with CVD is unknown. We aimed to investigate whether the dietary patterns of Saudi males, using the Saudi dietary guidelines adherence score, in parallel with the measurement of a selective number of cardiovascular disease-related biomarkers, are contributing factors to CVD risk. Demographics, dietary adherence score, and blood biomarker levels were collected for 40 CVD patients and forty non-CVD patients. Fasting blood glucose (p = 0.006) and high-density lipoprotein levels (p = 0.03) were significantly higher in CVD patients. The adherence score to the Saudi dietary guidelines was not significantly different between the CVD and non-CVD patients; however, the specific adherence scores of fruit (p = 0.02), olive oil (p = 0.01), and non-alcoholic beer (p = 0.02) were significantly higher in the non-CVD patients. The differences in CVD family history (p = 0.02) and adherence scores to specific groups/foods between the CVD and non-CVD patients may contribute to CVD risk in Saudi males. However, as the sample size of this study was small, further research is required to validate these findings.

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