Evaluation of inter-arm difference in blood pressure as predictor of vascular diseases among urban adults in Kancheepuram District of Tamil Nadu.

INTRODUCTION: An "Inter-Arm Difference" (IAD) in blood pressure (BP) is defined as a variation in systolic BP of >10 mmHg. Various studies conducted in different population show that there are wide variations in the prevalence of IAD, which ranges from 5% to 46%. The aim of this study is to evaluate the prevalence of IAD in BP among adults and its association with risk factors. METHODS: This community-based cross-sectional study was carried out among urban adults in Kancheepuram district. The study sample size of 1634 was calculated, and simple random sampling method was used. Data analysis was performed using SPSS software version 16. Prevalence of IAD in BP was calculated using percentages, and statistical significance was tested to look for an association. RESULTS: This study shows that 26.2% were at moderate risk for vascular events with IAD in systolic BP of 10-15 mmHg and 17.3% were at high risk with IAD >15 mmHg. About 14.2% had diastolic BP difference of 10-15 mmHg indicative of moderate risk and 6.1% had a difference of >15 mmHg indicative of high risk for vascular events. The statistical significant association was found between IAD in systolic BP and risk factors such as hypertension, smoking, alcoholism, and between IAD in diastolic BP with overweight/obesity (P < 0.05). CONCLUSION: This study outcome shows that the prevalence of IAD in BP is on the higher side. Hence, specific guidelines should be brought in to practice for measuring BP in both arms to detect IAD in every health-care settings.

Determinants of acute respiratory infections among under five children in a rural area of Tamil Nadu, India.

INTRODUCTION: Acute respiratory infection (ARI) is an infection of the respiratory tract. It may interfere with normal breathing of the individual and is communicable in nature. There are several modifiable risk factors that predispose younger age group of children to ARI. The aim of this study is to evaluate the risk factors that contribute to occurrence of ARI among the under 5 children. METHODS: This community based cross sectional study was carried out among 380 rural under five children in Kancheepuram district, by systematic random sampling method. A pretested structured questionnaire was used for data collection that was analyzed using SPSS software version 16. The analytical statistics such as Chi - square test, Odds Ratio, and Confidence Interval were used to determine the association of ARI with its determinants. RESULTS: In this study, the prevalence of ARI among under five children was 41.6%. The prevalence of ARI was predominant among boys (50.6%) and those residing in semi pucca and kutcha type of house (50.3%) with poor ventilation (61.3%), history of parental smoking (57%), respiratory infection among family members (51.1%) children who did not cry immediately after birth because of any complication (60.9%), and malnourished children (66.4%). These factors contributed to increased prevalence of ARI with a statistically significant association with a P value < 0.05. CONCLUSION: The high prevalence of ARI in this study was contributed by multiple factors. The primary care physician can play a vital role to create awareness on hazards because of exposure to the various contributing factors by lifestyle modifications, good nutrition, and healthy and safe environment.

The Need for Patient Follow-up Strategies to Confirm Diabetes Mellitus in Large Scale Opportunistic Screening.

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Type 2 (non-insulin dependent) Diabetes mellitus is one of the preventable non communicable disease resulting in increased morbidity and mortality in developing countries like India. It is characterized by disorders of insulin action and/or insulin secretion. Number of people with Type 2 Diabetes is growing rapidly worldwide with economic development, ageing populations, increasing urbanisation, dietary changes, reduced physical activity and lifestyle changes. The global prevalence of diabetes is 9%, while in India it is 8.63% and in Tamil Nadu it is 10.4%. National and State programmes on Diabetes control are implemented to combat the disease burden. A detailed review of the programme modules, operational guidelines and visit to health facilities were done to understand the implementation process related to control of Diabetes mellitus. As part of these programmes, opportunistic screening is implemented for target population. Though these programmes are unique, there are few lacunae identified which are missing opportunities and time consuming. There are no strategies so far in such programmes to make the screened positive cases to undergo confirmatory tests. Since screening is only opportunistic, the screened positive cases can be subjected to undergo confirmatory tests by different methods. The specified roles and responsibilities of health staffs at various levels to ensure follow up should also be framed and followed. The objective of this article is to review the existing strategies and to suggest the need for follow up pathways to be adopted from the first contact level to the level of final confirmation for better compliance.

Emphysematous pyelonephritis in a diabetic leading to renal destruction: pathological aspects of a rare case.

Emphysematous pyelonephritis is a severe, potentially fatal necrotizing pyelonephritis with a variable clinical presentation, ranging from mild abdominal pain to septic shock. The majority of cases occur in diabetics with poor glycemic control, while a small percentage may be due to urinary tract obstruction. We present a case of a 57 year old male patient, diabetic on treatment, presenting with left flank pain and poor stream of urine since one week. Laboratory tests revealed that the patient had electrolyte imbalance, ketoacidosis and high blood sugar. Urine culture was positive for Escherichia coli with a signifi cant colony count. Radiological examination gave a diagnosis of Left Type 1 Emphysematous Pyelonephritis. Inspite of giving vigorous resuscitation and antibiotics with nephrostomy, the patient had to undergo nephrectomy due to extensive renal parenchymal destruction. The nephrectomy specimen was studied in detail to know the histopathological findings in a case of diabetic patient with emphysematous pyelonephritis. We present this case not only because of it being a rare complication of diabetes, but also to focus on the histopathological findings of the same, documentation of which is limited in literature.