Impact of smoking on microalbuminuria and urinary albumin creatinine ratio in non-diabetic normotensive smokers.

Smoking is associated with an excessive morbidity and mortality from a variety of diseases. The aim of this study was to find out the effects of smoking on renal function study in non-diabetic, normotensive subjects. A community-based, prospective, cross-sectional cohort study was conducted on 120 subjects; 80 (66.66%) were smokers and 40 (33.33%) age matched non-smokers; with age range of 30 to 70 years. Measurement of fasting sugar, urea, creatinine, lipids and one time screening of urinary albumin and urinary creatinine was done. Smokers had significantly higher urinary albumin and albumin creatinine ratio (ACR) (52.84 ± 46.42 mg/L, 93.98 ± 78.68 µg/mg) than non-smokers (19.25 ± 7.77 mg/L, 18.99 ± 6.65 µg/mg), respectively (P =< 0.001, P =< 0.001). Microalbuminuria and urinary ACR level were directly related to the amount of smoking (pack-years). Among smokers, 73 (91.25%) had microalbuminuria (>20 mg/L) and 64 (80%) had increased urinary ACR (>30 µg/mg). Smoker had significantly lower high-density lipoprotein level (36.66 ± 10.28 mg/dl) compared to non-smokers (41.22 ± 11.72 mg/dl) (P = 0.031). Urea, creatinine, creatinine clearance, total cholesterol, low density lipoprotein, triglyceride levels were comparable (p = NS). In conclusion, smokers have a 4-fold higher prevalence of microalbuminuria than non-smokers.

Influence of smoking and hypertension on left ventricular mass.

OBJECTIVE: The present study was designed to observe the influence of smoking and hypertension on left ventricular mass (LVM), both individual and the combined effect. METHODS: This study was conducted in the Department of Medicine, SMS Medical College Hospital, Jaipur. Hundred patients were included in the study. They were divided into four groups--non smoker normotensives, non-smoker hypertensives, smoker normotensives and smoker hypertensives. They were also divided into smokers and nonsmokers and hypertensives and normotensive. Patients of age group 31-65 years of both sexes were chosen. Patients with secondary hypertension, diabetes mellitus, dyslipidemia, cardiomyopathies, valvular heart disease women on oral contraceptives were excluded from the study on the basis of history and relevant laboratory tests. An M-mode echocardiography was done and the LV mass was calculated by the formula proposed by Devereux et al. LV mass = 0.8 [1.04 (IVSd + LVIDd + LVPWd)3 - (LVIDd)3] + 0.6 gms RESULTS: The mean LV mass (in gms) in the four groups of nonsmoker normotensives, nonsmoker hypertensives, smoker normotensives and smoker hypertensives are 106.77 +/- 25.78, 165.3 +/- 42.55, 154.53 +/- 24.6 and 228.78 +/- 56.88 respectively. The comparison of mean LV mass (in gms) of smokers and nonsmokers were 191.66 +/- 40.74 and 136.04 +/- 36.16 (P < 0.001) respectively. The comparison of the mean LV mass (in gms) of hypertensives and nonhypertensives were 197.25 +/- 49.72 and 126.29 +/- 25.19 (P < 0.001) respectively. Comparison of the mean LV mass (in gms) of patient with two risk factors i.e., smokers hypertensives with patients without any risk factor i.e., nonsmoker normotensive were 228.78 +/- 56.88 and 106.77 +/- 25.78 (P < 0.001) respectively. While comparison of the mean LV mass (in gms) of patients with one risk factor each i.e., smoker normotensives and nonsmoker hypertensives were 165.3 +/- 42.55 and 154.53 +/- 24.6 (P < 0.05) respectively. CONCLUSION: Both smoking and hypertension cause an increase in LV mass, hypertension causing a more increase, than smoking, individually. Both smoking and hypertension combine together to increase the LV mass, more than either of them individually. Smoking by itself can cause an increase in LV mass independent of hypertension.

QT dispersion as a marker of left ventricular mass in essential hypertension.

Increased left ventricular mass is an important risk factor in hypertension for various cardiovascular complications. We studied 49 patients of essential hypertension and the relationship between QT dispersion (defined as the difference between the maximum and the minimum QT interval in a 12-lead electrocardiogram) and M-mode echocardiographic left ventricular mass was analysed. Criterion of left ventricular hypertrophy was left ventricular mass index above 134 gm/m2 in men and above 110 gm/m2 in women. There were a total of 22 patients with left ventricular hypertrophy (15 men and 7 women). The mean QT dispersion was 82.66 +/- 35.34 milliseconds (ms) in men with left ventricular hypertrophy and 36.66 +/- 15.71 ms in men without left ventricular hypertrophy. The mean QT dispersion was 77.14 +/- 29.27 ms in women with left ventricular hypertrophy and 26.66 +/- 9.99 ms in women without left ventricular hypertrophy. The correlation co-efficient was 0.59 (p < 0.001) and 0.69 (p < 0.01) in men and women, respectively. Hence, we conclude that there is a direct, linear and positive correlation between left ventricular mass and QT dispersion in essential hypertension.

Present status of drug resistance in cases of enteric fever in Rajasthan.

Drug Sensitivity of Salmonella typhi isolated from 30 blood culture positive cases of typhoid fever who presented between Nov. '93 to Aug. '94 was tested to determine their in vitro susceptibility to various antimicrobiols. 56.6% showed resistance to chloramphenicol, 70% to amoxycillin, 50% to amikacin, 43.3% to gentamycin, 40% to ampicillin, 33.3% to cotrimoxazole, 30% to cephalexin and very low resistance (6.6% each) to ceftriaxone and cefotaxime. All the 30 cases were sensitive to ciprofloxacin and ofloxacin. 17 chloramphenicol resistant typhoid cases in whom chloramphenicol was initially started failed to respond to this drug even after 4-5 days therapy, indicating that in vivo response matched with the in vitro sensitivity. Clinical response to ciprofloxacin, whether given initially or following chloramphenicol failure was prompt and satisfactory. Ciprofloxacin thus appears to be a good choice in such cases.

Echocardiographic features of mitral valve prolapse in Libyan patients.

Echocardiographic observations in 200 subjects with mitral valve prolapse (MVP) are presented. The diagnostic criteria used were: (1) abrupt late systolic posterior motion of one or both leaflets of the mitral valve, and (2) holoor pansystolic posterior motion of 3 mm of one or both leaflets of the mitral valve. Most of the subjects were young--72% were aged less than 30 years. Prolapse of posterior leaflets was noted in 98% of subjects--69.5% late systolic, 28.5% pansystolic, and 2% had prolapse of the anterior mitral leaflet only. Mitral valve prolapse was considered to be primary--being the only abnormality in 78.5% of the subjects. In the remaining 21.5% MVP was associated with other cardiac lesions, the commonest being, atrial septal defect (2.5%), dilated aortic root (2%), bicuspid aortic valve (2%), cardiomyopathy (5%), rheumatic heart disease (4%) and ischaemic heart disease (1.5%). Mitral valve prolapse was considered to be important enough to result in haemodynamically significant mitral regurgitation in only 8% of subjects. Mitral valve prolapse was the commonest single echocardiographic abnormality (16%) observed in patients referred to this university hospital, which is the referral centre for approximately half of Libya. Although this does not indicate the prevalence of MVP in the general population, this study indicates MVP to be the commonest valvular abnormality seen in hospital practice in Libya.