Risk factor assessment of stroke and its awareness among stroke survivors: A prospective study.

BACKGROUND: Stroke is the second most common cause of death and major cause of disability worldwide. The objective of this study is to identify the major risk factors and assess the awareness among the stroke survivors. MATERIALS AND METHODS: A prospective study was conducted at super specialty hospital, from December 2010 to July 2011. All the stroke patients of the age >25 years with either sex admitted in the hospital were included in the study. In order to assess the awareness among the stroke survivors, questionnaire established on the risk factors for stroke from the previously published studies. RESULTS: A total of 100 patients with stroke or cerebrovascular accident were included in the study. Of 100 patients, 73% patients had ischemic stroke and 26% patients had hemorrhagic stroke. The mean age of the patients was 50 years and the incidence of stroke was predominant in males 73%, followed by females 27. It was observed that 70% of patients were hypertensives, 28% were diabetics, 27% were alcoholics, and 24% of patients had a habit of smoking, followed by others. The knowledge of the risk factors for stroke in stroke survivors was also very low, and the knowledge was varied among the subjects according to their level of educational status. CONCLUSION: This study reveals that hypertension is the most common risk factor for stroke followed by diabetes, smoking, and dyslipidemia. The awareness of risk factor among stroke survivors was poor.

Assessment of treatment interruption among pulmonary tuberculosis patients: A cross-sectional study.

BACKGROUND: Multi-drug resistant tuberculosis (TB) is a rising peril of the TB control in India caused mostly by incomplete treatment. AIM: The aim was to assess the treatment interruption among pulmonary TB (PTB) patients. MATERIALS AND METHODS: A cross-sectional study was carried out for a period of 9 months among PTB patients. Patients admitted with active pulmonary Koch's and history of anti-TB treatment (ATT) for 1-month or more from any source and who returns to treatment after not taking ATT consecutively for 2 months or more were included in the study. The data were collected from the patients or their caretakers to obtain the source of treatment given previously before default, number of treatment interruptions, phase and reasons for treatment interruption treatment. RESULTS: A total of 107 defaulters were identified during the study period. In the present study, 62.6% of the patients interrupted treatment only once, 55.34% of the patient's early continuation (3-4 months) treatment, and 47.66% of the patient's only one reason for the treatment interruptions during the course of the treatment. The most common reason for the treatment interruptions were felt well with TB treatment (29.53%) followed by side effects (16.06%), lack of money (8.29%), and other reasons. CONCLUSION: The study revealed that most of the defaulters were in the age group between 35 and 60 years, male gender, illiterates, daily wage labor, and married. The treatment interruptions were minimized by putting the efforts to improve direct supervision; pretreatment counseling and retrieve treatment interrupters were recommended.

Assessment of drug-drug interactions in hypertensive patients at a superspeciality hospital.

OBJECTIVE: The objective of the study was to assess the incidence and pattern of drug-drug interactions (DDIs) in hypertensive patients by using Micromedex and Medscape databases. MATERIALS AND METHODS: A prospective observational study was carried out in a superspeciality hospital setting in South India for period of 9 months. Hypertensive patients who admitted into the hospital with the age more than 18 years, received more than 3 drugs per prescription and length of hospital stay for more than 24 hours were included in the study. An appropriate data was collected and assessed for DDIs with the help of Micromedex and Medscape databases. RESULTS: A total of 227 patients were enrolled during the study period. Among the 227 patients, 48 of them developed 53 clinically significant DDIs. Out of 48 patients, most of them were in the age-group of 50-60 years [18 (37.49%)]. The percentage of DDIs were higher in males [30 (62.5%)] compared to females [18 (37.5%)]. The most common drugs responsible for DDIs in the present study were Insulin [18 (33.96%)] followed by Metoprolol [10 (18.86%)], Torsemide [8 (15.09%)], and Hydrochlorothiazide [8 (15.09%)]. The most commonly interacting pairs were Ciprofloxacin-Insulin [6 (11.32%)], followed by Metoprolol-Insulin [4 (7.54%)] and Atenolol-Insulin [4 (7.54%)]. The most common consequences of interacting pairs were reduced serum potassium levels and hyperglycemia. CONCLUSION: The overall incidence rate of DDIs was found to be 21.14% and the increasing number of co-morbidities (P ≤ 0.003) and polypharmacy (P ≤ 0.002) were the risk factor for the development of significant number of DDIs.

Drug utilization pattern in South Indian pediatric population: A prospective study.

BACKGROUND: Studies on the process of drug utilization focus on factors related to prescribing, dispensing, administering and taking of medication and its associated events. AIMS: The aim of this study is to assess the prescribing patterns of medicines, apply the World Health Organization (WHO) core indicators and to assess the appropriateness of prescribed medicines in a pediatric unit. MATERIALS AND METHODS: A prospective observational drug utilization study was carried out in a pediatric unit of a super specialty hospital in South India for a period of 9 months. Patients who attended the pediatric unit with the age newborn to 18 years were included in the study and patients who were not willing to participate in the study were excluded and the data collected from the pediatric unit were analyzed. RESULTS: Out of 209 patients, the average number of drugs per patient was 4.56. The percentage of drugs prescribed with the generic name was found to be 19.16%. Among 209 prescriptions 49.78% of the drugs were essential drugs. Among the antibiotics 33.33% prescribed, cephalosporin group were the most commonly prescribed followed by amino glycoside and penicillin. Nearly, 21.80% of the medicines were given as intravenous and the prescriptions without drugs were 1.43%. Only 75.6% of patients have knowledge about their dosage schedule and almost all the prescriptions were appropriate. CONCLUSION: The assessment of WHO core indicators helped to improvise the prescribing pattern, identify significant problems involved in the knowledge gap of patients or caretakers understanding of instructions provided by consultants and even to minimize the cost burden on patient.

Cardiovascular risk among university students from developed and developing nations.

BACKGROUND: A key aspect in halting global increase in cardiovascular events is prevention and especially prevention at an early age. Unfortunately, global data regarding cardiovascular risk factors in the young are limited. Therefore the objectives of this study were to identify the most common cardiovascular risk factors among young adults in a university setting in both developed and developing countries. METHODS: Lifestyle and cardiovascular risk factors (smoking status, rates of physical activity, alcohol use, family history, blood pressure, fasting lipid panel, fasting blood glucose) were prospectively evaluated in young adults at three different university settings [University of Michigan (Ann Arbor, USA), University of Kalamoon (Deratiah, Syria), and Kakatiya University (Warangal, India)]. RESULTS: A total of 296 subjects (mean age and standard deviation 22 ± 3 years) were evaluated. Rates of current smoking were markedly higher (p < 0.001) in Syria (43%) compared with the USA (6.2%) and India (1.7%). Subjects in India were significantly (p < 0.001) less likely to engage in physical activity (20.2%) compared with the USA (90.7%) and Syria (68.8%). Fasting blood glucose levels and body mass index were significantly higher (p < 0.001) in Syria as compared to other countries. Significant differences were also noted in LDL, HDL, and triglycerides among the three sites. CONCLUSIONS: Cardiovascular risk factors among young adults in a university setting vary depending on global setting. Based upon the results of this study, targeted interventional programs based on risk findings from individual countries may be a reasonable future strategy to help reduce long term cardiovascular morbidity and mortality.

Study of insulin resistance in relation to serum IGF-I levels in subjects with different degrees of glucose tolerance.

AIM: We studied the correlations between fasting and post-lunch serum IGF-I concentrations, and insulin resistance and insulin sensitivity in subjects with various degrees of glucose tolerance. MATERIALS AND METHODS: A total of 12 nondiabetic subjects, 09 subjects with impaired glucose tolerance (IGT) and 18 patients with newly diagnosed type-2 diabetes of either sex (mean age, 46 years) were recruited. None of the participants received any drug treatment at the commencement of the study. Fasting as well as post-lunch blood samples were collected from all the subjects and anthropometric and biochemical parameters were analyzed. RESULTS: Fasting serum IGF-I concentrations were negatively correlated with fasting serum glucose, insulin, C-peptide, triglycerides, total LDL and VLDL cholesterol, homeostatic model assessment of insulin resistance (HOMA-IR), and age. Fasting serum IGF-I concentrations were positively correlated with fasting blood HDL cholesterol and homeostatic model assessment of insulin sensitivity (HOMA-S) in only diabetic subjects. Post-lunch serum IGF-I concentrations were positively correlated with HDL and LDL cholesterol. Correlations with HOMA-S with these metabolic anthropometric variables were of similar magnitude and direction as that of IGF-I concentrations. IGF-I concentrations were significantly lower in the subjects with World Health Organization-defined metabolic syndrome compared with the subjects without metabolic syndrome (P < 0.0001). CONCLUSIONS: Our data indicate that IGF-I could be a useful marker in the insulin resistance syndrome. The post-lunch low-IGF-I levels help in better identification of subjects at risk for type-2 diabetes mellitus and cardiovascular disease.