Effects of sleep deprivation on the cardiovascular health.

Aim: Insomnia is subjective perception of dissatisfaction with sleep quality and/or duration. The present study aimed to determine the effects of sleep deprivation on cardiovascular risk factors and health. Design, Place and Duration of Study: A cross-sectional study was conducted at Exservicemen Contributory Health Scheme (ECHS) Polyclinic, Sultanpur Lodhi, Kapurthala, Punjab, India from July, 2013 to Nov, 2013. Methodology: All the retired defence personnel and their family members (N=351) were assessed to study physical activity, body mass index (BMI), dietary habits, alcohol, hypertension, hyperglycemia, hyperlipidemia, stress, age, gender, employment, and education as determinants of sleep deprivation. The results were analyzed by Chi Square test with statistically significance of P value<.05. Results: The total prevalence of insomnia was 27.64% with higher frequency in females (52.57%) than males (47.42%). The prevalence increased with advancing age >50 years (81.43%), unemployment (75.25%), illiteracy (69.06%) and upper socioeconomic status (39.17%). A significant association of insomnia with hypertension (59.80%; P<.05) and stress (28.86%; P<.001) was found. Alcohol (24.40%) and active lifestyle (38.58%) had shown protective role in sleep adequacy. However, sleep deprivation had no significant relation with obesity, metabolic syndrome, dietary practices, blood glucose, and lipids levels. Conclusion: Insomnia and its significant relation with hypertension and stress increases cardiovascular risk which requires appropriate interventions by identifying those at the risk of chronic insomnia and its associations with females, advancing age, physical inactivity, low education level and unemployment.

Sex Related Assessment and Differentiation of Atherogenic Risk Factors.

Aims: Atherosclerosis is latent precursor of clinical cardiovascular disease. The present study aimed to assess modifiable and non-modifiable atherogenic risk factors in both sexes. Study Design: Cross sectional design. Place and Duration of Study: It was conducted at Exservicemen Contributory Health Scheme (ECHS) Polyclinic, Sultanpur Lodhi, Kapurthala, Punjab, India from June, 2013 to Oct, 2013. Methodology: This study was undertaken to assess age, education, employment, socioeconomic status, physical activity, body mass index, dietary habits, family history, sleep, stress, dysglycaemia, hypertension and dyslipidemia as determinants of atherogenic risk factors. The level of significance was defined by P<.05 with Chi Square test. Results: All patients (N=351) were divided into male (49.58%) and female (50.42%) cohorts. A statistically significant males (45.41%; P<.001) were found >65 years old and females (43.51%; P<.001) in 51-65 years. Males had significant higher literacy (55.19%; P<.001) and employment status (55.75%; P<.001). Females were reported with significant positive family history (40.12%; P<.01), stress (25.99%), sleep inadequacy (28.82%; P<.001), sedentary lifestyle (83.62%; P<.001), and vegetarianism (74.02%; P<.01). Metabolic syndrome was more prevalent in females (19.78%) than males (14.95%). The higher prevalence of hypertension (females: 49.16%; males: 48.28%), obesity (females: 23.72%; males: 17.24%), dysglycaemia (females: 25.99%; males: 22.42%) was recorded in females; and dyslipidemia (males: 29.32%, females: 23.17%) in males. Conclusion: Females were reported with significantly higher frequencies of atherogenic risk factors which make them highly susceptible to cardiovascular events than males. Hence, sex should be considered to assess and differentiate atherogenic risk factors, and when health professionals recommend lifestyle modifications.

Prevalence and Effects of Various Risk Factors Influencing the Blood Pressure Values.

Aim: Hypertension is major cardiovascular risk factor contributing to all cause mortality. The present study was aimed to determine the impact of socio-demographic variables and risk factors on the blood pressures (BP) of the subjects. Place and Duration of the Study: A cross sectional study was conducted at Ex- Servicemen Contributory Health Scheme (ECHS) Polyclinic, Sultanpur Lodhi, Kapurthala, India from June to Oct, 2013. Methodology: All retired defense personnel and their family members (N= 351) who attended polyclinic during study period were recruited to assess physical activity, body mass index, dietary habits, alcohol, family history, sleep, stress, over the counter (OTC) medications, employment status, and education as determinants of BP. The results were analyzed by Chi Square test with statistically significance of P value <0.05. Results: The frequency of high BP as per JNC VII guidelines was observed as 47.90% with higher range in females (51.19%) than males (48.80%). The frequency significantly increased with age >50years (88.08%; P<0.001), unemployment status (76.19%; P<0.05) and low education levels (37.50%; P<0.05). An association of high BP with inadequate sleep (35.11%; P<0.05), sedentary lifestyle (63.69%), alcohol (26.78%), positive family history (36.30%), stress (20.83%), non-vegetarian dietary habits (44.64%), increased BMI (67.26%; P<0.05) and OTC medications misuse (15.47%) was found. Half of the subjects were diagnosed with high BP for more than five years (49.40%), two-third had controlled (67.26%) and compliant (69.64%) status, and more than two-third had awareness about their diagnosis of high BP (83.60%). The uncontrolled status, non-compliance towards treatment, and low awareness level regarding high blood pressure values was found among 32.73%, 30.35% and 08.19% of subjects, respectively. Conclusion: This rising frequency of high BP and its associated factors must be monitored, treated and controlled by appropriate preventive and therapeutic approaches including lifestyle modifications, Dietary Approach to Stop Hypertension, weight loss and maintenance, physical activity, stress management and pharmacotherapy.

An Overview of Diabetic Neuropathy.

Purpose of Review: Diabetic Neuropathies are a heterogeneous by their symptoms, pattern of neurologic involvement, course, risk covariates, pathologic alterations, and underlying mechanisms that result into mono- and polyneuropathies, plexopathies and radiculopathies. It also ranges from subclinical functional impairment of cardiovascular reflexes and sudomotor functions to severe cardiovascular, gastrointestinal, or genitourinary dysfunction. Orthostatic hypotension, Resting tachycardia, and Heart Rate unresponsiveness to respiration are the hallmarks of Diabetic Autonomic Neuropathy. Diabetic Peripheral Neuropathy greatly affects all areas of a patient’s life, including mood, sleep, self-worth, independence, ability to work, and interpersonal relationships. This review provides an overview of definition, etiopathogenesis, clinical assessment, diagnosis and management of the patients with Diabetic Neuropathies. Summary and Results: Good clinical history and complete physical examination are the basis of assessment followed by therapeutic and laboratory studies. Strict glycemic control along with early detection and control of hyperlipidemia and hypertension, daily aspirin, smoking cessation and alcohol consumption in moderation may help to prevent, delay, or slow the progression of Diabetic Neuropathy. The main classes of agents used to treat Diabetic Peripheral Neuropathic pain include Tricyclic antidepressants, Anticonvulsants, Serotonin-Norepinephrine Reuptake Inhibitors, Opiates and Opiate-like substances, and topical medications. However, only two medications are approved specifically for the treatment of Diabetic Peripheral Neuropathic pain: Pregabalin and Duloxetine. Management must be individualized for each patient based on efficacy, side effects profiles and drug accessibility including cost.

A case report: Unsafe abortion.

Unsafe Abortion constitutes a major cause of maternal morbidity and mortality in developing countries. It is randomly practiced though exact statistics is not available due to lack of cooperation from concerned parties. Complications occur in a large portion of these cases which ultimately require tertiary care. This case report of complications associated with an unsafe abortion highlights the need for raising the awareness among women and healthcare providers regarding education on contraception and availability of safe and legal abortions with better access to abortion and post abortion services.