ABSTRACT
Background: Hypertension is a major risk factor contributing to cardiovascular and cerebrovascular diseases and death. Medical officers play an important role in Indian public health care system. The objective of this study was to evaluate the impact of training program on knowledge about hypertension among medical officers working in government health centres in Gujarat, India.Methods: A one day training program was conducted for medical officers of various Primary Health Centres (PHCs) and Community Health Centres (CHCs) in Narmada district of Gujarat. This training focussed on screening, diagnosis and management of hypertension, essential and secondary hypertension, lifestyle modifications, various anti-hypertensive drugs and practical aspects of examining a patient with hypertension. Impact of the training program was evaluated by a questionnaire consisting of 10 questions which was used as a pre-test and a post-test.Results: A total of 30 medical officers (18 male and 12 female) attended the training. The mean age of participants was 37.4 years and average clinical experience was 11 years. The pre-test mean score of participants was 4.52 and post-test mean score was 8.44. This improvement in the post-test mean score was found to be statistically significant. On comparison of questions answered incorrectly in pre-test and post-test, we found that there was a significant reduction in the number of questions answered incorrectly in the post-test.Conclusion: There was a significant improvement in the knowledge of medical officers regarding screening, diagnosis and management of hypertension as a result of their training.
ABSTRACT
Background: Patients with chronic kidney disease require arteriovenous fistulas for hemodialysis. The aim of our study was to share our experience of creating arteriovenous fistulas for hemodialysis and to analyze the factors affecting the outcome of arteriovenous fistulas.Methods: This is a prospective study carried out in Guru Gobind Singh Government Hospital, Jamnagar from August 2013 to July 2015. All patients with chronic kidney disease in whom arteriovenous fistula was created surgically for hemodialysis were included in this study.Results: Maximum patients (34%) were in the age group of 51-60 years. 76% of the patients were males and 24% were females. Co morbid conditions like diabetes mellitus, hypertension and ischemic heart disease were present in 20%, 26%, and 16% of patients respectively. Success rate of arteriovenous fistulas in patients with diabetes mellitus, hypertension and ischemic heart disease was 30%, 69.2% and 25% respectively. Success rate of arteriovenous fistulas in patients without diabetes mellitus, hypertension and ischemic heart disease was 92.5%, 83.8% and 90.5% respectively. Early failure was present in 20% of the patients. Most common cause of early failure was thrombosis, which occurred in 8% of total patients. Other causes of early failure were wound infection, stenosis and aneurysm, which occurred in 6%, 4% and 2% patients respectively.Conclusions: Presence of diabetes mellitus and ischemic heart disease was associated with a higher risk of arteriovenous fistula failure. The success rate reported in our study was fairly acceptable.
ABSTRACT
Background: Pancytopenia is one of the common laboratory findings in patients presenting to us with varied clinical presentations. Risks of untreated Pancytopenia are high causing anxiety to treating doctors and patients alike. It also involves long list of investigations including a very painful marrow biopsy, life-threatening complications and treatment involves multiple blood component therapy. A total of 101 cases of pancytopenia over a period of 1 year were analysed retrospectively to find i) commonest presenting symptoms ii) commonest cause of pancytopenia, response to treatment iii) Depending on the cause, to consider if any measures can be taken for preventionMethods: Cross sectional study of 101 admitted patients of Pancytopenia on the basis of information extracted from the case sheets. The data was analyzed and presented as frequencies and Percentages.Results: Out of 101 cases analysed, 53 (52.47%) were females 48 (47.52%) patients males. Fatigue 74 patients (73.2%) was the commonest presenting symptom followed by fever 33 (32.6%), breathlessness 13 (12.87%) and bleeding 4(3.8%). Vitamin B12 deficiency 58 (57.6%) patients showed and was the commonest cause of pancytopenia. Infections in 24 (23.7%) like malaria16 (15.6%), dengue 5 (4.96%), PLHA 1(0.96%) and hepatitis B 2 (1.96%) was the second common cause in present study. Recovery of pancytopenia was prompt in Malaria Dengue. HIV, Hepatitis B viral infection showed persistent pancytopenia with hypoplastic marrow. Chronic liver disease portal hypertension splenomegaly accounted for 9 (8.9%) patients. Drug induced marrow suppression due to ongoing treatment for underling disease resulted in pancytopenia in 4 (3.96%) patients. Aplastic anaemia in3 (2.9%), myelodysplastic syndrome 2 (1.9%) and acute leukaemia 1 (0.96%) were the less common causes.Conclusions: Commonest symptom on presentation were related more to anaemia than to neutropenia and thrombocytopenia. megaloblastic anaemia due to Vitamin B12 deficiency was the leading reversible cause of pancytopenia in present study followed by infections like Malaria Dengue. Gujarat, India being predominantly vegetarian state, local dietary habits are thought to be responsible for inadequate B12 daily consumption, hence we suggest fortifying the daily diet with B12 supplementation at a larger scale just like iodisation of salt to counter iodine deficiency.