Study of Lipid Profile in Newly Diagnosed Hypertensive Patients.

Back ground: Hypertension is one of the most important modifiable risk factors for cardiovascular disease (CVD) and stroke. Dyslipidemia is closely associated with hypertension. Dyslipidemia and hypertension are the commonest risk factors for CVD. The aim of the present study was to compare different lipid parameters among newly diagnosed hypertensive patients with normotensive subjects in Bangladesh and find out the relationship. Methods: This study was a cross sectional study in which 42 newly diagnosed hypertensive patients who were on no antihypertensive medication and 42 subjects with normal blood pressure (normotensive) were enrolled for compare. Lipid parameters total cholesterol (TC), triglyceride (TG), low density lipoprotein ( LDLc) and high density lipoprotein (HDLc) were estimated by Enzymatic colorimetric test. Results: The mean systolic blood pressure of hypertensive and normotensive were 154.6±22.5 vs111.50±3.42 mmof.Hg and mean diastolic blood pressure were 93.2±5.20 vs 71.44± 3.21mm of Hg. The mean of SBP and DBP of hypertensive patients was found to be higher than normotensive (p< 0.05). There was significant increase in different lipid levels namely TC 199.4±44.5 vs188.7±37.9 mg/dl, TG155.9±88.8 vs 121.9±73.2 mg/dl and LDLc 119.8±35.6 vs112.7±28.6 mg/dl in hypertensive patients as compared to normotensive (p<0.05). However there was no significant difference in HDLc level. BMI and waist circumference showed significant association in hypertensive patients (p<0.001). Conclusion: Analytical results of the study revealed that hypertensive patients have been found to have close association with dyslipidemia, BMI and waist circumference. Hypertension and dyslipidemia can be modified either by proper life style changes or medical management or by the combination of the both. This study suggests that hypertensive patients need measurement of blood pressure and lipid profile at regular interval to prevent heart diseases and stroke.

A New Concept in Relation to Blood Biochemical Parameters with Myocardial Infarction in Bangladeshi Population.

Background : Blood testing for biochemical markers of Myocardial injury plays an increasingly important role for the evaluation, diagnosis and triage of patients with chest pain. The guidelines for the diagnosis of Myocardial Infarction ((MI) have recently changed and prominently incorporate the results of cardiac marker testing in the clinical definition of MI. We investigated these updated biomarkers and further compare the differing biology and release kinetics of clinically relevant biomarkers. Methods: Biochemical changes that occurred in the blood of acute myocardial infarction (AMI) patients were investigated. Two hundred and fifty two patients, 180 males and 72 females were included in this study. The mean age was 49.3 ± 9.25 years. Biochemical parameters include serum triglyceride, total protein, albumin , total bilirubin and total cholesterol to albumin ratio were analyzed. Results : Biochemical parameters showed that the increased level of triglyceride and total bilirubin were associated with myocardial infarction. Triglyceride and total bilirubin levels in myocardial infarction patients were 2.3 ±1.4 mmol/ L and 12.3±3.2 μmol/ L respectively, whereas those of healthy controls were 1.7±1.2 mmol/L for triglycerides and 9.7±3.7 μmol/L for bilirubin. On the other hand, serum total protein and albumin concentrations were lower in MI patients compared to those of controls. Total protein level was 65.5 ±3.1 g/L in MI patients and 76.2±5.3 g/L in healthy controls. Albumin levels in both patients and controls were 40.2 ±3.2 g/L and 45.4 ± 4.5 g/L correspondingly. Conclusion : Interestingly, serum total cholesterol level was not significantly different in MI patients compared to controls. In addition, cholesterol/albumin ratio in myocardial infarction patients (0.14 ± 0.04) found to be significantly higher than in healthy controls (0.11± 0.03).

The Metabolic Syndrome: Comparison of Newly Proposed IDF, Modified ATP III and WHO Criteria and their Agreements.

Background: Metabolic syndrome (MS) results from clustering of cardiovascular risk factors occurring in association with insulin resistance and obesity. With the increasing prevalence of obesity worldwide, MS is of keen interest in research. The disorder is defined in various ways, but one consolidated definition is needed to make studies comparable worldwide. The study was to determine the risk factors of metabolic syndrome in Bangladesh and comparison of newly proposed definition of International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) and the World Health Organization (WHO) criteria and their agreements. Materials and Methods: This was a cross sectional hospital based study. We randomly selected 229 participants. After obtaining informed written consent data collectors collected data by interview, clinical examination, anthropometric measurement and investigations. We calculated independent sample t-test means between to distinguish which risk factors were present in participants with and without MS, using SPSS v17. Results: The percentage of risk factors of MS among subjects according to different criteria was 72% of Modified ATP-III, 69% of IDF and 39% of WHO definition .In Modified NCEP ATP III when did independent sample t-test mean of BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose, high density lipoprotein and triglyceride were present statistically significant difference between without MS and with MS (p<0.05). According to WHO criteria BMI, waist circumference, fasting blood glucose were statistically significant (p<0.05) and similarly fasting blood glucose & triglyceride were statistically significant difference between without MS and with MS (p<0.05) according to IDF criteria.ATP III and WHO criteria showed good agreement (k 0.56) compared to ATP III with IDF (k 0.31) and WHO with IDF (k 0.11) criteria. Conclusion: Metabolic syndrome is highly prevalent in Bangladesh. We detected the highest proportion of participants with MS using the ATP III definition, which emphasizes the predominant focus on the modified waist circumference for Asian participants. However, MS prevalence following WHO criteria in those with impaired glucose regulation is comparable with ATP III definition. Follow up study needed to examine the significance of MS following all definitions for the assessment of risk for diabetes and or cardiovascular disease.

Serum Creatinine and Blood Urea Nitrogen Levels in Patients with Coronary Artery Disease.

Background: Few studies have assessed the relation of Serum creatinine and serum blood urea nitrogen (BUN) level with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid BUN levels with the presence of Coronary artery disease. Materials and Methods: This study was designed as an observational cohort study. The study was composed of 170 patients admitted at our institution due to symptoms related to CAD. Patients having angiographic evidence of stenosis in coronary artery were as case group and without stenosis control group. Patients with high serum creatinine were defined as serum creatinine concentration with in 80-105 μmol/L and BUN level with in 10-20 μmol/L. The presence of CAD has been defined as the Gensini score being >1. Results: Patients with or without CAD were similar in terms of age (45.22±6.80 years vs. 52.87±9.31 years, p<0.01) and significant age difference was found between patients. Male gender (p<0.001) and smoking habit (p=0.003) were more frequent and statistically significant in patients with CAD. There was a statistically significant difference between the mean serum creatinine levels (92.89±20.82 μmol/L vs 108.68±23.62 μmol/L respectively, p<0.05) and serum blood urea nitrogen level (10.59±6.15 μmol/L vs. 20.37±6.73 μmol/L respectively, p<0.01) of patients with or without CAD. While looking at the correlation coefficient of Gensini score with different factors; S. creatinine, ejection fraction and BUN were significantly correlated at<0.001 and <0.04 and <0.01 level respectively. Increased serum creatinine levels were found to be independent risk factors for the presence of CAD (for serum cretinine hazard ration 3.9, p<0.001 and in case BUN hazard ration 2.08, p<0.001). Conclusion: In conclusion, a significant association has been found between serum creatinine & BUN level and the presence of CAD. In addition to the evaluation of conventional risk factors in daily clinical practice, the measurement of serum creatinine and BUN level might provide significant prognostic benefits in terms of global cardiovascular risk and management of the patients.

Adjuvant chemotherapy with six cycles of AC regimen versus three cycles of AC regimen followed by three cycles of Paclitaxel in node-positive breast cancer.

Context: Antracycline-Cyclophosphamide (AC) along with Paclitaxel/Docetaxel, either in combination or sequential regimens, is showing superior results than Anthracycline-containing regimens. Aims: This study was designed to determine whether adding Paclitaxel to a standard adjuvant chemotherapy regimen AC for breast cancer patients would prolong the time to recurrence and survival. Settings and Design: Randomized, prospective, open-labeled, single-institutional study. Materials and Methods: Fifty stage II breast cancer patients accruing 25 patients in each arm, treated between July 2007 and January 2010, were included in the study. Initial surgical treatment was Modified Radical Mastectomy. Systemic therapy was to have begun within 4-6 weeks of the patient's surgery. In the control arm, all the patients were treated with six cycles of adjuvant chemotherapy with AC regimen repeated at an interval of 3 weeks. For the study arm, the patients received adjuvant chemotherapy with three cycles of AC regimen followed by three cycles of Paclitaxel, repeated at an interval of 3 weeks. All the patients of both the arms received locoregional external beam radiotherapy (EBRT) after the entire course of chemotherapy. All the hormone receptor-positive patients received Tamoxifen. Statistical Analysis Used: Statistical analysis was performed using the chi-square test and the Kaplan Meier survival analysis with the log-rank (Mantel-Cox) test. Results: Adding Paclitaxel to AC resulted in a statistically significant disease-free survival. The overall survival was also improved significantly. The toxicity profile in both the arms was comparable. Conclusions: In early and node-positive breast cancer, the addition of three cycles of Paclitaxel after completion of three cycles of AC improves the disease-free and overall survival.

Primary squamous cell carcinoma of kidney - a case report of unusual local recurrence with literature review.

Primary squamous cell carcinoma of the kidney is a rare clinical entity. Primary squamous cell carcinoma is more frequently reported in urinary bladder and male urethra than in kidney. Primary renal squamous cell carcinoma (RSCC) accounts for less than 5% of urothelial tumours in urinary system. Very few cases of primary squamous cell carcinoma of kidney have been reported in the world literature. Only forty-six cases over forty four years had been reported from Mayo Clinic. These neoplasms are highly aggressive and locally advanced or metastatic at the time of presentation. Here we report such a case of primary squamous cell carcinoma of kidney in a 50-year-old lady at a locally recurrent stage with fistulous tract formation. Palliative radiotherapy came out to be a good clinical modality even in locally recurrent stage in this patient.

Serum Uric Acid and Its Association with Coronary Artery Disease.

Background: Few studies have assessed the relation of uric acid level with the severity of coronary artery disease (CAD). This study investigated the association between high uric acid levels with the presence and severity of CAD. Materials and Methods: This study was designed as an observational cohort study. The study was composed of 180 patients admitted at our institution due to symptoms related to CAD. Patients having angiographic evidence of stenosis in coronary artery were as case group and without stenosis control group. Patients with high uric acid (hyperuricemia) were defined as serum uric acid concentration >7.0mg/dl or >420 μmol/L in men and >6mg/dl or >360 μ mol/L in women. The presence of CAD has been defined as the Gensini score being >1. Results: There was a statistically significant difference between the mean uric acid levels of patients with and without CAD (358.23±71.11 μmol/l vs251.32±54.92 μmol/l respectively, p<0.001). There was a statistically significant difference between ejection fraction of patients with and without CAD (54.50±9.25 vs. 63.16±6.56 respectively, p<0.001). Spearman correlation analysis demonstrated a positive correlation between the serum uric acid level and the severity of CAD (p=<0.001, r=0.39). When patients were classified into four groups according to their Gensini score, mean serum uric acid level was found to be significantly increased across the tertiles, and a statistically significant difference was detected between the tertiles (p= <0.001). Conclusion: In conclusion, a significant association has been found between serum uric acid level and the presence and severity of CAD. In addition to the evaluation of conventional risk factors in daily clinical practice, the measurement of uric acid level might provide significant prognostic benefits in terms of global cardiovascular risk and management of the patients.

A trial on the Effects of Life Style Interventions in High-Normal Blood Pressure.

Background: This experimental (Intervention) study was conducted with objective of evaluating the outcome of non-pharmacological approach (lifestyle intervention) through reducing the modifiable risk factors on high normal blood pressure or pre-hypertension (systolic blood pressure130- 139mm of Hg and diastolic blood pressure 85-89 mm of Hg).The study was provided risk reduction management intervention was given on subjects of high normal blood pressure through adequate physical activity, tobacco cessation, dietary advice for unhealthy to healthy diet, reduction of salt intake, reduction of over weight & stress management etc. Materials and methods: The study was conducted among 434 respondents aged 30 -50 years during the period from June 2008 to May 2009 with intervention for 6 months.Random sampling, those cases were fulfilled the inclusion and exclusion. High-normal BP were found out through BP measurement & clinical examination then sample population were selected by randomization: odds numbers in study group (intervention group) and even numbers in control group (comparision group). After obtaing informed consent data were collected by interview, clinical examination, anthropometric measurement and investigations. It was three phases, first phase were case identification & intervention for study group, second phase was follow up and third phase was outcome measurement for both groups. Cases were hold a record card with contact number. Results: After six month mean difference of blood pressure, lipid profile, weight were changed both the groups but changed was significant in the study group. Mean systolic blood pressure reduced 4.1±6.0 in the study group and 1.2±6.4 in the control group,(p< 0.001). Mean diastolic pressure reduced 3.5±4.9 in study group and 1.2±6.4 in control group (p<0.001). Mean total cholesterol, LDL cholesterol and triglycerides decreased in the study group 19.7±18.6, 10.6±14.6 and 15.4 ±21 respectivley and in control group mean of all these parameters decreased to 11.5±16.5, 5.1±12.9 and 6.7±23.2 respectively. Mean HDL cholesterol for men and women in the study group was raised to 5.6±5.9 and 4.5± 6.4 respectively (p<0.001). Mean weight reduced 1.94±1.59 in study group and 0.06±1.44 in the control group (p<0.001). Conclusion: The final outcome of the study was that mean high normal blood pressure was found to reduced due to intervention of non- pharmacological management. So, If we encourages subjects after 40 years for routine health check up in hospital setting & service for risk factor detection & management (preventive cardiology), we will reduce the risk factors of high normal blood pressure (pre-hypertension) & cardiovascular diseases to some extent. Encourages population to stay with normal blood pressure & healthy life style.

Morbidity profile of paediatric inpatents at a community health centre and a nearby [correction of near by] district hospital in northern India.

The study was conducted to ascertain the morbidity profile among children by retrospective review of inpatient data of children admitted to Comprehensive Rural Health Services Project (CRHSP), Ballabgarh, a model CHC and Badshah Khan (B.K.) hospital, Faridabad, a district hospital over a period of one year. Diarrhea and pneumonia comprised 64% of all admissions at the model CHC and 30% at the district hospital. Thalassemics requiring blood transfusion formed 21% of inpatients at the district hospital. Common paediatric ailments can be managed appropriately at CHC level, provided the infrastructure as recommended by Indian Public Health sandards for CHC under National Rural Health Mission (NRHM) is available. The blood bank or blood storage facility at a CHC is desirable.

Gender inequality and severe malnutrition among children in a remote rural area of Bangladesh.

Bangladesh typifies many south-eastern countries where female children experience inferior health and uncertain survival, especially after the neonatal period. This paper attempts to study the gender inequality in nutritional status and the effects of various socioeconomic, demographic, and health-programme factors on gender inequality in a remote rural area of Bangladesh. Measurements of mid-upper arm circumference (MUAC) were taken from 2,016 children aged less than 5 years (50.8% male, 49.2% female) in 1994. Children were characterized as severely malnourished if MUAC was < 125 mm. Independent variables included various characteristics of children, households, and mothers. Average MUAC for all children was 130 mm; 33% were severely malnourished. Of the severely-malnourished children, 54.2% were female, and 45.8% were male. The gender gap persisted in the multivariate situation, with female 1.44 times more likely to be severely malnourished. Other variables with a statistically significant relationship included the age of children, acceptance of DPT1, and education of household heads. The persistence of such a gender discrimination now when the country has achieved a lot in terms of child survival is striking. The issue is important and demands appropriate corrective actions.

Isolation and characterization of nonhistone proteins associated with DNase-II hypersensitive sites of Sarcoma-180 chromatin.

Limited digestion (2 min) of Sarcoma-180 nuclei by DNase-II released two nonhistone proteins from the hypersensitive sites of chromatin. The apparent molecular weights of these two proteins were 34 and 21 kDa. These proteins showed a moderate but specific inhibition in in vitro cell free transcription assay with native chromatin as template as opposed to no effect on native DNA transcription.

Effect of anthracycline antibiotics on in vitro transcription of chromatin in a Sarcoma-180 whole cell extract.

A soluble extract capable of transcribing Sarcoma-180 chromatin and DNA in a cell-free transcription system was prepared from Sarcoma-180 mouse ascites tumour cells. Incorporation of [3H]UTP into trichloroacetic acid-precipitable fraction is (i) reduced by 50% on removing DNase I hypersensitive sites of chromatin and (ii) inhibited by DNA binding antitumour anthracyclines, suggesting that this cell-free assay represents true transcription of active genes of Sarcoma-180 chromatin. Preparation of this soluble extract from mouse ascites tumour cells thus presents a very convenient way of studying cell-free transcription of active genes of chromatin and effect of antitumour agents on chromatin transcription.