Factors affecting seasonal changes in blood pressure in North India: A population based four-seasons study

Objective There are no community based, longitudinal, intra individual epidemiological studies on effect of weather and season on blood pressure (BP). We evaluated the effect of season and temperature on prevalence and epidemiology of BP in tropical climate. Methods and results It was a longitudinal cross sectional survey of rural and urban subjects in their native surroundings. BP was measured in four different seasons in same subjects. A total of 978 subjects (452 rural and 521 urban) were included in the current analysis. Demographic characteristics such as age, gender, education, occupational based physical activity and body mass index (BMI) were recorded. Mean BP, both systolic and diastolic were significantly higher in winter season as compared to summer season. Mean difference between winter and summer was 9.01 (95% CI: 7.74–10.28, p < 0.001) in systolic BP and 5.61 (95% CI: 4.75–6.47, p < 0.001) in diastolic BP. This increase in BP was more marked in rural areas and elderly subjects. Prevalence of hypertension was significantly higher during winter (23.72%) than in summer (10.12%). Conclusion BP increases significantly during winter season as compared to summer season. Increase is more marked in rural areas and elderly subjects. Seasonal variation in BP should be taken into account while looking at prevalence of hypertension in epidemiological studies.

Loop‑mediated isothermal amplification assay for detection of Mycobacterium tuberculosis complex in infertile women.

Background: Female genital tuberculosis (FGTB) has a profound impact on the reproductive health of patients including infertility. Conventional diagnostic techniques have low sensitivity and specificity as well as long turnaround time. There is a need of developing newer, rapid and practically adaptable technique, especially in low‑income countries. Objective: To standardize and evaluate loop‑mediated isothermal amplification (LAMP) technique for diagnosis of FGTB. Methods: A total of 300 endometrial biopsy samples from infertile females were subjected to Ziehl–Neelsen (ZN) staining, Lowenstein–Jensen culture, automated culture (BACTEC mycobacterial growth indicator tube), histopathological examination (HPE), nucleic acid amplification by polymerase chain reaction (PCR) and LAMP technique. Composite gold standard (either smear/culture/HPE/PCR positive) was considered for calculation of outcome parameters. Results: The observed sensitivities of ZN smear, culture, HPE, PCR and LAMP were 2.94%, 10.29%, 8.82%, 95.59% and 66.18%, respectively. Overall concordance between PCR and LAMP was 63%, which shows a good agreement. Conclusion: This study is the first to evaluate LAMP in the diagnosis of FGTB and found it to be a rapid and convenient technique, especially in low resource endemic settings.

Steroid responsive prolonged thrombocytopenia in dengue.

Prolonged thrombocytopenia in a usual case of dengue virus infection is uncommon. Dengue-related thrombocytopenia is self-limiting and responds within 3-5 days. An underlying immunological disorder may be responsible for delayed return of platelet count to a normal level. We present a case of prolonged thrombocytopenia in a case of dengue hemorrhagic fever. The response to steroids suggests a possible immunological dysfunction.

Hyperuricemia and pregnancy induced hypertension--reappraisal.

Serum uric acid estimation was done in forty primigravidae with pregnancy induced hypertension and twenty normotensive primigravida in the third trimester of pregnancy, at delivery and six weeks postpartum. The mean serum uric acid levels in normotensive women in the antenatal period and at delivery were 4.65 +/- 0.33 and 4.88 +/- 0.23 mg% and in mild PIH were 5.42 +/- 0.55, 6.14 +/- 0.76 mg%, respectively. Level of serum uric acid in mild PIH was significantly higher than normotensive women (P). In severe PIH, the mean serum uric acid levels were 6.65 +/- 0.60, 8.24 +/- 1.09 mg% in antepartum and at delivery respectively which was significantly more than control group and mild PIH group women (P). However, no differences was observed, in the serum uric levels between these groups during the postpartum period. Serum uric acid level of 5.5 mg or more was observed to be an indicator of PIH. Levels of serum uric acid did show a high positive correlation with the severity of PIH in relation to hypertension and proteinuria. Hyper uricemia (more than 5.5 mg% is associated with increased perinatal morbidity and mortality.

Hyperuricaemia and perinatal outcome in pregnancy induced hypertension.

The effect of hyperuricaemia on perinatal outcome was evaluated in 40 primigravidae with pregnancy induced hypertension and 20 normotensive women in the 3rd trimester of pregnancy. Serum uric acid level was a better indicator than blood pressure as an index of foetal prognosis. Even severe hypertension without hyperuricaemia was associated with better prognosis for the foetus. Conversely when hypertension was mild and hyperuricaemia was severe, the prognosis for the foetus was poor. A rise in serum uric acid level > or = 5.5 mg% is associated with increased perinatal morbidity and mortality. Women in pregnancy induced hypertension group with serum uric acid level > or = 5.5 mg% had a higher incidence of intra-uterine growth retardation, low birthweight, and stillbirth making perinatal mortality rate of 200/1000 total births. The results of this study indicate that serum uric acid level > or = 5.5 mg% can reflect the perinatal outcome.

Identification of infertile couples in a rural area of northern India.

An attempt was made to identify infertile couples in a rural area of India, utilizing the existing information structure. A three stage screening of the cases was done. Initial record based listing was done with the help of the health workers' records. Cases on initial list were screened on the basis of information obtained from key informants in villages. Verified cases were then individually contracted. Total catchment population (28839) in 40 villages of a Primary Health Centre (PHC) of north India was surveyed by a lady social worker. Of the total 4453 eligible couples in the PHC, 129 (2.9%) were infertile (46.5% primary and 53.5% secondary infertility). From the initial list of 298 cases, 161 (54%) were excluded during the survey. The yield from the health workers' record was 33 per cent whereas from key informants it was 93 per cent. The study revealed that the key informants and existing information structure can be utilized to identify conditions like infertility in rural areas, after proper verification of initial reports.