ABSTRACT
Introduction: Prevalence of coronary artery disease (CAD) is on the rise in Sri Lanka resulting in high hospital mortality rates. Because of paucity of community based data on CAD we carried out this study to assess prevalence of CAD and associated factors in a suburban population in Southern Sri Lanka. Methods: A cross sectional descriptive study was carried out among community living adults aged 30 years or more in Bope-Poddala Medical Officer of Health (MOH) area. Total of 1000 eligible individuals were recruited using cluster sampling. Cardiovascular Questionnaire of London School of Hygiene was administered to each participant by trained data collectors. CAD was diagnosed using criteria by Epstein and colleagues and electrocardiograms were classified according to the Minnesota code by a Cardiologist blinded to participant details Results: Total of 579 (57.9%) females and 421 (42.1%) males were studied. Mean age of the group was 53 years. Among the participants 32% had cardiovascular risk related non communicable diseases (NCDs) and 22.2% had a family history of the same. Prevalence of CAD was 6.9% (95% CI: 5.33 - 0.47) and silent ischaemia was 2.2% (95% CI: 1.29 - 3.11). Only gender and past history of cardiovascular risk related NCDs emerged as predictors of CAD Conclusions: CAD was more prevalent among males and those with past history of cardiovascular risk related NCDs. Community based preventive programmes should be implemented to minimize the adverse impact of CAD.
ABSTRACT
OBJECTIVE: a. To confirm the efficacy of subcutaneous morphine infusion for postoperative analgesia and compare this effect with three-hourly subcutaneous bolus injections of morphine. b. To evaluate the suitability of a simple micro-infusion set to deliver subcutaneous infusion, as conventional infusion pumps are expensive and not readily available. SETTING: Double blind, prospective controlled clinical trial. PATIENTS: 21 patients belonging to the American Society of Anaesthesiologists' (ASA) classes I or II, who underwent major elective abdominal surgery were studied in an intensive care unit. INTERVENTION: All patients were given loading doses of morphine intravenously (iv) followed by subcutaneous (sc) infusion in two groups and three-hourly sc bolus injections in the third group. The doses were titrated on an individual basis. The infusion was delivered by a power driven pump in one group and by a microinfusion set in the other. Those with significant pain during this regime were given morphine supplements intravenously. MEASUREMENT: Pain scoring was done hourly using a modified verbal rating scale. The percentage of patients who required intravenous supplements in each group was compared to draw statistical conclusions. RESULTS: 1. Subcutaneous infusion provided adequate analgesia in 86% of the patients studied. 2. There was no significant difference between the groups in terms of additional iv supplement requirement. 3. The microinfusion set required frequent readjustments to maintain constant flow. CONCLUSIONS: Intermittent subcutaneous bolus injections of morphine given through an indwelling butterfly needle is a simple, safe, and effective method for postoperative analgesia after major abdominal surgery. Simple infusion sets are not suitable to deliver subcutaneous infusions, and the need for infusion pumps makes the infusion technique unsuitable for routine use in wards.