Comparative Evaluation of Angiotensin-Converting Enzyme Inhibitors for their Beneficial Effects in Patients with Ischemic LV Systolic Dysfunction and Undergoing Coronary-Artery Bypass Surgery.

We compared three angiotensin-converting enzyme (ACE) inhibitors, captopril, perindopril, and ramipril, in the presented prospective study for their effectiveness in patients having left ventricular (LV) systolic dysfunction and undergoing coronaryartery bypass grafting (CABG). We enrolled 27 patients in captopril, 43 patients in perindopril, and 70 patients in ramipril group. There was about 25%–36% rise in LVEF after 3 and 6 months of ACE inhibitor administration in all three groups. The reduction in LV diameters did not differ significantly amongst the three groups. There was a significant decrease (p < 0.05) in LV end-diastolic diameter from baseline levels in captopril and perindopril groups after 3 months that got increased after 6 months but remained below pretreatment levels in both the groups. In ramipril group, there was no much change in this parameter from baseline levels at 3 and 6 months of treatment. After 6 months of treatment, the percent reduction in LV end-systolic diameter was also sustained in perindopril-treated patients. The percent reduction was greater in the perindopril group (3 and 6 months: 7.39 ± 5.94 and 7.73 ± 3.43, respectively) as compared to that observed in captopril group (3 and 6 months: 5.67 ± 1.05 and 2.52 ± 3.11, respectively) and ramipril group (3 and 6 months: 7.30 ± 2.75 and 4.93 ± 3.22, respectively). Mitral-valve regurgitation was greatly reduced in the captopril group at 3 as well 6 months of ACE inhibitor administration. However, the percent reduction from baseline levels was not statistically significant amongst the three groups. The percent improvement in functional status was significantly greater in the ramipril treatment group (36.46 ± 3.14) after 6 months of treatment as compared to that of captopril (6.67 ± 10.64) and perindopril (4.17 ± 2.73) group. In conclusion, our data show equal beneficial effects with all three ACE inhibitors under investigation in CABG patients with LV systolic dysfunction, with marginal superiority for perindopril.

Study of interspouse communication and adoption of family planning and immunization services in a rural block of Varanasi District.

Interspouse communication was studied in some pertinent areas which have an important bearing on day to day transactions. The level of such communication measured on a three-point scale was studied for its role on acceptance of family planning and immunization services. 200 currently married females residing with their husbands in a rural block of Varanasi, in the reproductive age group, with at least one child aged 1-3 years were selected and interviewed. Scores were ascribed for 12 selected items of conversation according to frequency of conversation on a three point scale based on which high, medium and low communicators were delineated. In this study high, medium and low communicators were found to be 14%, 40% and 45% respectively. Topics of importance which never featured in interspouse communication were menstrual problems (44%), when to have first child (82.5%) and birth spacing (48.5%). Interspouse communication was better in upper castes and joint families. Literacy status of both husband and wife and per capita income of the family revealed positive relationship with inter-spouse communication. Adoption and practice of family planning methods as well as full immunization coverage of the child in the family were observed to be higher among high and medium communicators as compared to low degree of communcators (p < 0.001).

Estimating true burden of disease detected by screening tests of varying validity.

Timely and accurate information on disease load is essential for planning health programs. Unfortunately, complexity, cost and need of skilled personnel limit the use of screening tools of high validity in developing countries. The disease load estimated with tools of low validity differs considerably from true disease load, particularly for diseases of extreme levels of prevalence/incidence. A tool of 70% sensitivity and specificity may yield a prevalence/incidence rate of 34% (CI: 32.23-35.67%) for a disease whose true rate is only 10.0% (CI: 8.94-11.06%). We proposed a procedure to derive the true estimate in such cases, based on the concepts of sensitivity and specificity of a diagnostic/screening test. It is applied on two sets of real data--one pertaining to incidence rate of low birth weight (LBW) and the other to prevalence rate of obesity--where multiple screening tests of varying validity were used to estimate the magnitude. Different screening tests yielded widely varying incidence/prevalence rates of LBW/obesity. The prevalence/incidence rates derived by using the proposed estimation procedure are similar and close to the true estimate obtained by screening tests considered as gold standard. Further, sample size determined on the basis of the results of a tool of low validity may be either larger or smaller than the required sample size. Estimation of true disease load enables determination of correct sample size, thus improving the precision of the estimate and, in some instances, reducing the cost of investigation.

A qualitative assessment of ante-natal care provided by auxillary nurse midwives.

Two hundred sixty eight antenatal mothers were observed for the quality of services provided by Auxillary Nurse Midwives (ANMs). History taking was found to be satisfactory in only 2.6% women. Obstetric examination was done unsatisfactorily in majority (52.6%) of the mothers. General physical examination was not done in 69% women. ANMs in all 31 sub-centres were not performing investigation like haemoglobin estimation, urine testing, foetal heart sound monitoring and blood pressure recording.

Screening for obesity in affluent females: body mass index and its comparison with skin fold thickness.

In the present study 625 females above 15 years of age residing in affluent localities of Varanasi city were selected by multi-stage stratified random sampling technique. Body Mass Index (BMI) and Skin-Fold Thickness (SFT) were compared as indices of obesity. Prevalence of obesity by BMI and SFT was 30.24 and 49.12 respectively. SFT gave significantly higher prevalence rate of obesity as compared to BMI. It is possible that western population based SFT cut-off points may not be truly applicable to Indian study. The sensitivity, specificity and predictive value of 'sum of SFT at four sites' were calculated at different cut-off points, and it was observed, that values > or = 90 mm is the best cut-off point instead of 80 mm, for detecting obesity in the Indian context.