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Background Although pulmonary abnormalities have been recognized in patients with inflammatory bowel diseases (IBD), their prevalence and clinical significance are not known. Aim To study the prevalence and clinical significance of pulmonary abnormalities in patients with IBD. Methods Ninety-five non-consecutive patients with IBD (12 Crohn’s disease, 83 ulcerative colitis; mean age 41.9 [SD 13] years; 47 women) were prospectively studied from January 2007 to March 2010. Pulmonary function tests (PFT) and high-resolution CT (HRCT) chest were performed in them. PFT were compared to those in 270 healthy (control) subjects matched for age, sex and smoking status. Results Twenty-seven (28.5%) patients and 11 (4%) control subjects had abnormal PFT (p<0.0001). Small airway obstruction was seen in 18 patients, restrictive defect in six and mixed defect in three. Twenty-one (22%) patients had abnormal HRCT findings – bronchiectasis and nodules (nine patients each, including one with nodules who later developed active tuberculosis after infliximab therapy), parenchymal bands (8), mediastinal lymphadenopathy (five, including two with tuberculosis on histology and culture), emphysema (5), brochiolitis (2), pleural effusion or thickening (2), pericardial effusion (2), patchy consolidation (1), ground-glass opacities (1) and lung metastasis (1). Three patients had symptoms (one asthma, two cough). Conclusion PFT and HRCT chest showed abnormality in about one-quarter of patients with IBD. A majority of patients with these abnormalities were asymptomatic.
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Introduction Non-adherence to medical therapy is emerging as an important determinant of relapse in patients with inflammatory bowel disease (IBD). Aim To find the prevalence of and reasons for nonadherence to medical therapy in Indian patients with IBD and its correlation with disease outcome. Methods In this cross-sectional study, we checked for adherence to treatment in 127 patients with IBD (117 ulcerative colitis and 10 Crohn’s disease) using a questionnaire that inquired into frequency of missed doses, causes for missed doses, and its relation to relapse of disease. Results Of the 127 patients (mean age 42.8 years; 68 women), 103 (81%) were non-adherent to treatment, defined as taking 80% or less of the dose advised. The reasons for non-adherence (not mutually exclusive) were: forgetfulness– 98 patients (77%), felt better–18 (14.2 %), high frequency of doses–13 (10.1%), no effect of medications–10 (7.87%), non-availability of medications–3 (2.3%). Non-adherent patients were three times more likely to develop a relapse as compared to those with adherence (OR 3.389, 95% CI 1.29–8.88, p=0.012). Conclusions Over 80% of patients with IBD in this survey were non-adherent to medical treatment; forgetfulness was mentioned as the most common cause. Non-adherent patients were more likely to relapse. Patients need to be educated regarding the need for adherence to treatment in IBD.
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BACKGROUND: There is a paucity of data on the relative importance of various traditional risk factors for coronary artery disease among rural Indians. We conducted a prospective case-control study to determine the risk factors for acute myocardial infarction in a rural population of central India. METHODS: We recruited 111 consecutive patients admitted to our hospital with a first episode of acute myocardial infarction and 222 age- and sex-matched controls. Demographics, anthropometric measures, lipids, blood glucose, smoking and other lifestyle factors were compared among cases and controls. Multivariate analyses were used to identify the risk factors independently associated with acute myocardial infarction. RESULTS: Elevated fasting blood glucose (odds ratio [OR] 8.9; 95% confidence interval [CI] 4.5, 17.9), abnormal waist-hip ratio (OR 3.0; 95% CI 1.7, 5.4) and income (OR 4.0 and 5.9 for the high- and middle-income categories, compared to the lowest category) were independently associated with the first episode of acute myocardial infarction. Abnormal triglycerides (OR 1.7; 95% CI 0.9, 3.1) and current smoking (OR 1.9; 95% CI 0.9, 4.0) were risk factors but were not statistically significant. CONCLUSION: Reduction in blood glucose levels and truncal obesity may be important in controlling the burden of coronary artery disease in rural Indians.