Study of microalbuminuria in essential hypertension patients with target organ damage

Background: Urinary albumin excretion has been purported to be strongly linked to cardiovascular events in hypertensive patients. The prevalence of microalbuminuria in patients with essential hypertension and its relationship with target organ damage was evaluated with the present study, as the correlation of microalbuminuria and target organ damage except cardiovascular events has not been deliberated upon much in the past.Methods: One hundred and twenty cases of essential hypertension were enrolled sequentially. Prevalence of urinary albumin excretion and its correlation with target organ damage (left ventricular hypertrophy, retinopathy and stroke) was analyzed. Urinary albumin excretion was assessed by turbidimetry method, while microalbuminuria was calculated by urine albumin to creatinine ratio.Results: Microalbuminuria was observed in 57.7% cases of essential hypertension. Target organ damage was observed in 62.5% (75) patients, out of which 78.66% patients had associated microalbuminuria (p<0.05). Higher prevalence was observed in patients with longer duration and greater severity of hypertension, increased body mass index and dyslipidemia.Conclusions: The assessment of microalbuminuria in hypertensive patients is a great value addition for the evaluation of target organ damage. Prompt control of hypertension and lipid levels along with weight management may lead to decreased risk of microalbuminuria.

Study of cross-referrals to the dermatology department in an inpatient setting at a tertiary care centre

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.

Study of pulmonary hypertension as a complication of sickle cell disease

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.