ABSTRACT
Background: Sickle cell anaemia is the most common inherited hematological abnormality across human race, particularly prevalent in pockets of central India and pulmonary hypertension (PH) supposedly worsens prognosis. Data from central India is lacking though. Present study aims to study incidence of pulmonary hypertension as a complication in patients of sickle cell disease.Methods: Patients aged more than 12 years diagnosed to have sickle cell anaemia on hemoglobin electrophoresis during the study period (total- 94; 54 SS and 40 AS) were enrolled as cases. Sixty four age/sex matched healthy close relatives of the cases with 慉A� Hb electrophoresis pattern doubled up as controls. Participants were thoroughly assessed with complete history, examination, haematological and biochemical tests, X-ray chest, ECG, pulmonary function tests and 2D-echocardiography and Doppler studies and data analysed.Results: Pulmonary hypertension was observed in a total of five SS cases (5/54, 9.26%). No participant from the AS group or the control group developed pulmonary hypertension. It was more common in females (3/23, 13%) than males (2/26, 7.7%). The mean age of the SS cases with PH (32�15 years) was found to be significantly higher than that of the SS cases without PH (24.2�21 years) (p<0.01).Conclusions: The incidence of PH in sickle cell disease was relatively lower as compared to western countries and was found to affect females and older individuals more. Larger community-based studies are recommended for corroboration.
ABSTRACT
Background: Chronic Kidney Disease (CKD) is a risk factor for development of cardiovascular diseases. Cardiovascular diseases are the predominant cause of morbidity and mortality in patients with CKD. There is limited data on cardiovascular diseases among CKD patients from developing countries including India. With the present study, the prevalence and patterns of cardiac diseases among patients with CKD were profiled.Methods: This was a cross sectional study in which 217 patients with CKD were studied over a period of two years and six months. Data on demographic characteristics and risk factors for cardiovascular diseases were collected using a standardized questionnaire. Cardiac evaluation was done using resting ECG and echocardiography.Results: One hundred eighteen (54.4%) patients had either eccentric or concentric LVH. Patients with LVH were more likely to be hypertensive (p<0.001) or anemic (p=0.034). Up to 9.2% of study subjects had valvular heart disease (rheumatic or degenerative) and 22% had pericarditis. Patients with pericarditis were more likely to have a serum urea concentration greater than 60mg/dl (p=0.327). Forty-one patients (18.9%) had left ventricular systolic failure (EF<50%). There was a statistically insignificant higher prevalence of systolic failure in patients with LVH (21% vs. 16%), (p=0.346). Thirty-eight participants (17.5%) had diastolic failure while 2% had cardiac rhythm abnormalities.Conclusions: Cardiac abnormalities are common in a relatively young Indian population with CKD. Clinicians should routinely screen and manage cardiovascular disease in CKD patients.
ABSTRACT
Background: Till recently, dermatology was primarily being considered to be an outpatient focused discipline. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. This study was conducted to analyse the incidence and indications for inpatient dermatology referrals and the impact of dermatology consultation on patient management.Methods: A cross-sectional study was undertaken by analyzing the records of 243 patients referred to dermatology department over a 2-year period. Descriptive analysis was conducted in the form of study of presumptive diagnoses by the referring clinicians, causes of referral, distribution of referrals across specialties and the dermatological opinions with respect to diagnosis and management etc.Results: Clinically significant change was documented in the course of skin lesions management of almost two-thirds of referred patients. Maximum referrals were from the department of general medicine with “skin rash” being the most common cause for seeking 2nd opinion. Concordance for diagnosis between the referring clinician and the dermatologist was observed in only 30.2% of the cases.Conclusions: Dermatologic referral does lead to improved patient care. But there is need for better training of non-dermatologists enabling them to recognize and treat common skin lesions.