Prevalence of risk factors for coronary artery disease among adults in a rural area of Tamil Nadu

Background: Lifestyle changes have increased the epidemic of obesity, diabetes, hypertension (HTN), dyslipidemia, and cardiovascular diseases in the 20th century. In India, the estimated adult prevalence of coronary artery disease (CAD) is increasing which leads to a huge economic loss. Objectives: The objective of the study is to measure the prevalence of risk factors for CAD among population aged 30 years and above in a rural area of Tamil Nadu. Materials and Methods: A community-based cross-sectional study was done in 16 villages under the field practice area of the Department of Community Medicine, Pondicherry Institute of Medical Sciences. 631 participants were selected by multistaged random sampling and interviewed using modified WHO-STEPS questionnaire. The variables studied were age, sex, socioeconomic status, smoking, alcohol, diet, physical activity, obesity, diabetes, and HTN. Data analysis was done using SPSS version 20. Results: Out of 631 participants interviewed in this study, the prevalence of smoking was 13.8%. 29.6% respondents had consumed alcohol once in their lifetime. Almost all the respondents (99.5%) did not consume fruits and vegetables adequately. Majority of the participants consumed salt dense foods and used unsaturated oil for cooking. Only 17.8% were sedentary workers. 32.5% were pre-hypertensives and 25.8% were hypertensives. 28.2% were overweight and 6.6% were obese. Conclusion: The prevalence of various risk factors for CAD such as unhealthy diet, obesity, alcohol consumption, and comorbidities was found to be high among our study population. Hence, concerted efforts should be taken by various stakeholders to reduce the risk of developing CAD.

Prevalence of osteoarthritis of knee joint among adult population in a rural area of Kanchipuram District, Tamil Nadu

Background: Osteoarthritis (OA) is one of the most common degenerative disorders among the elderly population; although aging is the most important cause, research has shown that it is a complex disease with many etiologies. It is not an inevitable part of aging but rather the result of a combination of factors, many of which can be modified or prevented. Objective: The objective of this study was to assess the burden and determinants of OA knee among the adult population. Methods: A community-based, cross-sectional study among 1986 adult persons living in a rural area in Kanchipuram district, Tamil Nadu, South India, was interviewed and examined from January 2014 to December 2014. Data collection was done by the postgraduates, trained health workers under the supervision of principal investigator. Written and informed consent was obtained before data collection. OA was diagnosed using the criteria laid down by the American College of Rheumatology, and it was validated and tested in the study area. Results: A total of 1986 adult respondents were interviewed out of which 27.1% had OA of knee. Age more than 50 years, female gender, tobacco usage, illiteracy, lower socioeconomic class, positive family history of OA, diabetes, and hypertension were found to be associated with OA knee (P < 0.05). Conclusion: The burden of osteoarthritis knee was high in this region. Hence, effective preventive strategy has to be taken to minimize this burden.

Analysis of Efficacy & Safety of Inhaled Tiotropium and Tiotropium Plus Formoterol in COPD.

A randomized, open labeled comparative analysis for 2-week therapy of inhaled Tiotropium (T) (n=30) and Tiotropium plus Formoterol (TF) (n=30) once daily was carried in stable COPD patients. Objective parameters like lung functions (FEV1 and FVC), SBP, DBP, pulse and subjective parameters like improvement in respiratory symptoms & safety were assessed at baseline and after 2 weeks of treatment. Mean FEV1 was 1.0963±0.3826 & 1.1657±0.3701 as well as 1.1227±0.4129 & 1.2260±0.3830 before & after treatment with inhaled T & TF respectively. A statistically significant p<0.05 and p<0.001 improvement was only observed for FEV1 without significantly affecting other study parameters with two treatment modalities respectively when analyzed from respective base lines. However, on comparing the post drug improvement in objective & subjective parameters among T & TF treatment arms showed statistically insignificant p>0.05 variation. Both the regimens were well tolerated and no case warranted withdrawal of treatment. The present study suggests that in the treatment of COPD, inhaled long acting bronchodilators (T & TF) on comparison appear equally effective & safe.

Cubitus varus--correction by distraction osteogenesis.

Cubitus varus deformity in thirty children was corrected by gradual medial opening wedge osteotomy. The osteotomy was stabilized and distracted by simple external fixator-cum-distractor. The patients of both sexes and age from 6 to 14 years, had varus deformity from 17 degrees to 43 degrees. We achieved good to excellent results in 28 cases as regards to correction of deformity and range of motion at elbow joint. None of the cases had neurological deficit or permanent stiffness. One case had fair result due to under-correction and another case had a poor result as osteotomy united before correction. The main complication faced was superficial pin-site infection particularly in summer season and a in fatty children but was managed by good pinsite dressing and care. The technique has been found to be quite effective, technically simple, cosmetically acceptable and with little, if any, lazy S deformity.

Isolated cardiac aspergillosis.

A 40-year-old man, a known case of Wolff-Parkinson-White syndrome, was admitted to the hospital in an unconscious state. In spite of medical treatment, the patient died within two hours of admission. At autopsy, the deceased was found to have aspergillosis involving the interatrial septum, aortic valve and root of the aorta. The rest of the organs were unremarkable. The patient did not show any obvious signs of being immunocompromised. We report this case of isolated cardiac aspergillosis in an apparently healthy individual.

Haemostatic changes in children with cyanotic and acyanotic congenital heart disease.

This study was undertaken to screen children with congenital heart disease for coagulation abnormalities and to compare the groups of cyanotic and acyanotic children with congenital heart disease with respect to abnormalities of the coagulation system. Following investigations were done in all the patients: complete blood count, erythrocyte sedimentation rate, peripheral smear examination, bleeding time, prothrombin time, activated partial thromboplastin time, assay of fibrinogen, D-dimer, factors VII and VIII and antithrombin III. Red cell indices were determined in 12 control, 12 acyanotic and 20 cyanotic children. Twenty-five patients each, with echocardiographically proven cyanotic and acyanotic congenital heart disease under 12 years of age constituted the study group; as many children of the same age group were included as the control group. The results showed isolated abnormalities of laboratory tests with equal frequency (28%) in acyanotic and cyanotic groups but coexisting abnormalities of more than one test were seen in significantly larger number of cyanotic children (5/25 and 16/25, respectively). A significant association was noted between thrombocytopenia and a high haematocrit in cyanotic patients. It is concluded that laboratory abnormalities of tests of haemostasis are more common in cyanotic congenital heart disease patients. The patterns of laboratory abnormalities suggest a chronic compensated disseminated intravascular coagulation at a subclinical level, reduced synthesis of clotting factors and/or deranged platelet aggregation in different subgroups of patients.

Medullary thyroid carcinoma with melanin production--a case report.

Melanin production in medullary thyroid carcinomas is rare. The present case illustrates melanin and other atypical features of medullary carcinoma of the thyroid in a fifty year old female. The diagnosis was suggested on the cytomorphological features seen on fine needle aspiration cytology smears. On histo-pathological examination the tumor was extensively pigmented with frequent mitosis. Amyloid was conspicuously scarce. Confirmation of diagnosis was done by immunohistochemical positivity for calcitonin and HMB-45 on tissue sections. The case is being presented in view of its rarity and distinct immunoreactivity. Review of literature is done and the implications of such dual positivity in the histogenesis and divergent phenotype of this tumor are discussed.

Renal dysplasia: an autopsy study of associated congenital malformations.

A retrospective analysis of infant autopsies in the last 14 years was done with the aim of determining the frequency of associated malformations. Renal dysplasia comprised 36 of 594 autopsies done and was the commonest congenital urologic malformation (6.06% of all infant autopsies). Histologically all cases were characterised by hallmarks of disordered metanephric differentiation and organisation. Extrarenal malformations were seen in all (100%) of the cases of which other urologic anomalies were the commonest (28) followed by those of musculoskeletal (18), gastrointestinal (13), cardiovascular (10) and central nervous system (6). Syndromic association was seen in 5 (14%) cases. There were twenty two percent still births and 47% infants died perinatally. A thorough search for systemic malformations is mandatory in all cases of renal dysplasia as these may influence the survival significantly. Cystic renal dysplasia should be differentiated from other causes of cystic renal diseases.

Basaloid-squamous carcinoma. A distinct histopathological entity.

Basaloid Squamous Carcinoma (BSC) is an uncommon aggressive neoplasm occurring in the upper aerodigestive tract. Lung as a primary site has only recently been reported. A combination of microscopic features is required to make a diagnosis and to differentiate it from other more common malignancies in these sites. Three cases of BSC including one in the lung are reported. There are no prior published reports of this neoplasms in Indian literature. The study highlights the typical microscopic features and the diagnostic difficulties which may be encountered.