ABSTRACT
Objective Hypertension is the most important risk factor for cardiovascular morbidity and mortality. There is limited data on hypertension prevalence in India. This study was conducted to estimate the prevalence of hypertension among Indian adults. Methods A national level survey was conducted with fixed one-day blood pressure measurement camps across 24 states and union territories of India. Hypertension was defined as systolic blood pressure (BP) ≥140 mmHg or a diastolic BP ≥90 mmHg or on treatment for hypertension. The prevalence was age- and gender-standardized according to the 2011 census population of India. Results Blood pressure was recorded for 180,335 participants (33.2% women; mean age 40.6 ± 14.9 years). Among them, 8,898 (4.9%), 99,791 (55.3%), 35,694 (11.9%), 23,084 (12.8%), 9,989 (5.5%), and 2,878 (1.6%) participants were of the age group 18–19, 20–44, 45–54, 55–64, 65–74, and ≥ 75 years, respectively. Overall prevalence of hypertension was 30.7% (95% confidence interval [CI]: 30.5, 30.9) and the prevalence among women was 23.7% (95% CI: 23.3, 24). Prevalence adjusted for 2011 census population and the WHO reference population was 29.7% and 32.8%, respectively. Conclusion There is a high prevalence of hypertension, with almost one in every three Indian adult affected.
ABSTRACT
Background: A comparative prevalence studies using modified WHO and more stringent criteria of WHF2012 have not been conducted in this part of the country and so authors felt necessary to conduct such study in this North-eastern state of India.Methods: In this cross-sectional study, 3600 children aged 5-15 years (11.07±2.86, 51.90% male) from randomly selected schools of Manipur were examined clinically and by 2D colour doppler echocardiography.Results: Only one case of Clinical RHD with a combination of MR and AS was found, (prevalence of 0.28/1000) [CI: 0.04-1.97). Echocardiography detected 3 cases of definite subclinical (prevalence rate of 0.83/1000 (CI: 0.27-2.58], 14 cases of borderline subclinical RHD (prevalence rate of 3.9)/1000 (CI: 2.30-6.56) befitting WHF 2012 criteria, and 61 cases of borderline subclinical RHD befitting modified WHO criteria (prevalence rate of 16.9/1000)[ CI1.3-2.1].On follow up to 5 years, among the 3 cases with definite subclinical RHD, 2 had worsened and 1 remained non- progressive, while among the 14 subclinical borderline cases, 2 normalized, 6 remained non-progressive and 6 children were lost to follow up.Conclusions: Prevalence of RHD using echocardiography is several folds higher compared to clinical examination alone. While the number is reduced by about half using WHF criteria. However, the important of WHO criteria cannot simply be neglected, as all the subclinical cases by WHF criteria remains non-progressive, while one case of subclinical defined by WHO worsen on follow up.
ABSTRACT
Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals. Nevertheless, the coiling of the collaterals in certain specific case scenarios is not feasible, rendering the management of a lung bleed, all the more challenging. We, hereby discuss a case of a 7-year-old girl with a massive endotracheal bleed at the time of weaning from cardiopulmonary bypass after corrective surgery for TOF. The subsequent approach and management are discussed. The optimal management of tetralogy with collaterals mandates an effective communication among the cardiologist, radiologist, anesthesiologist, and the surgeon.
ABSTRACT
Background & objectives: Though diabetes affects multiple organs, most studies highlight the occurence of only one complication in isolation. We conducted a hospital-based study to estimate the co-existence of significant systemic co-morbid conditions in patients with varying grades of diabetic retinopathy. Methods: A total of 170 consecutive patients with diabetic retinopathy were prospectively recruited for the study between June 2009 to June 2010 at a tertiary care eye centre in north India. Retinopathy was graded by fundus biomicroscopy and fundus photography and classified into three categories (mild-moderate nonproliferative retinopathy, proliferative retinopathy requiring only laser and proliferative retinopathy requiring surgery). Nephropathy was classified by calculating the six variable estimated glomerular filtration rate (eGFR) for all patients. Nerve conduction studies and clinical assessment were used to determine presence of neuropathy. Co-existence of macrovascular disease and peripheral vascular disease was also ascertained. Results: The percentages of patients with overt nephropathy in the three groups were 19.2, 38.0 and 41.2, respectively. Significant linear trends were observed for serum creatinine (P=0.004), albumin (P=0.017) and eGFR (P=0.030). A higher per cent had abnormal nerve conduction on electrophysiology than that diagnosed clinically (65.4 vs. 44.2, 76.0 vs. 40.0 and 64.8 vs. 48.6, respectively). The odds ratio (95% CI) for co-existence of nephropathy, neuropathy, CVA (cerebrovascular accidents) and PVD (peripheral vascular disease) was 2.9, 0.9, 4.8 and 3.5, respectively. Independent of retinopathy severity, patients with clinically significant macular oedema (CSME) had a higher percentage of nephropathy (pP < 0.005). Interpretation & conclusions: The co-existence of overt nephropathy, nerve conduction based neuropathy and macrovascular co-morbidity in patients with early grades of diabetic retinopathy was significant. Screening for overt nephropathy by eGFR should be considered in all patients with clinically significant macular oedema.