RESUMEN
Background: Non communicable diseases (NCDs) are primarily driven by the modifiable risk factors that often emerge during the childhood/adolescence and contribute towards majority of premature deaths during adulthood. This study aimed to assess the prevalence of multiple NCD risk factors and the associated factors among adolescents in urban and rural areas of Rajasthan. Methods: It was a community-based cross-sectional study conducted among 430 school going adolescents. A self-administered questionnaire adapted from STEPS survey format of the WHO and indian adolescent health questionnaire was used; anthropometric measurements were taken using standard procedure. Presence of two or more risk factors in one individual was considered as clustering of NCD risk factors. Results: Prevalence of two risk factors (Dyads) was 48.8% (urban) and 33% (rural), three or more risk factors were found in about 12.1% urban and 7.9% rural adolescents. For “Dyads”, males had OR 3.58 (95% CI 1.9- 6.4) and OR 4.1 (95% CI 2.6-7.9) in urban and rural areas, respectively. The risk of clustering was higher with increasing age [Dyad: OR 1.26 (CI 1.1-5.73) in urban, OR 2.2 (CI 1.56-3.7) in rural; ? 3 risk factors: OR 2.3 (CI 1.98-4.11) in urban, OR 1.52 (CI 1.21-4.9)]. Conclusions: Clustering of the risk factors was prevalent among urban as well as rural adolescents emphasizing the importance of developing primary prevention strategies which can be effective across all demographic and socioeconomic backgrounds.
RESUMEN
Maintenance of adequate oxygen balance to all tissues is one of the primary objectives when dealing with patients undergoing cardiac surgery. Cardiac output is one of the major components of oxygen delivery so that its maintenance is an important consideration. Due to pre-operative cardiac lesion and myocardial dysfunction secondary to the events related to cardiac surgery and cardiopulmonary by-pass, circulatory support by pharmacological or mechanical means is frequently required after surgery. Therefore, inotropes and vasodilators are used to improve the myocardial performance after cardiac surgery. Epinephrine, dopamine and dobutamine are commonly used inotropes. Dopexamine and phosphodiesterase inhibitors such as amrinone, milrinone and enoximone are some of the newer agents that have been introduced in clinical practice. Amongst the vasodilators, sodium nitroprusside and nitroglycerin are commonly used. Alpha adrenergic blockers such as phentolamine and phenoxybenzamine and calcium channel blockers such as diltiazem are some other vasodilators that can be used. Many units still regard epinephrine as an inotrope of choice and use its predominant beta agonist effect in the dose range of 0.02 to 0.04 mg/kg/minute. Some prefer dobutamine and others a combination of inotrope and vasodilator or an inodilator. Phosphodiesterase inhibitors can be useful in certain situations such as pre-existing ventricular dysfunction or when stunning of the myocardium is suspected with down regulation of beta receptors. Dopamine is useful in the renal vasodilating dose to improve renal perfusion and improve output. There is no ideal inotrope at present and each one has its own drawbacks. The clinician must learn to use the inotropes (especially the newer ones) based on his own clinical experience.