Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India.

OBJECTIVES: Hypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction. METHODS: We conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities. RESULTS: Of 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group. CONCLUSIONS: This study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

Role of nuclear morphometry in diagnosis of salivary gland neoplasms.

BACKGROUND: Fine needle aspiration cytology is an important diagnostic tool in salivary gland cytopathology. However, cytology of salivary gland neoplasms shows diversity with morphological overlap, heterogeneity and subjective variability, posing diagnostic challenge. Nuclear cytomorphometric image analysis turns the subjective criteria into quantitative parameters, which may aid not only in differentiating between benign and malignant tumours but also can aid in categorising challenging cases with morphological overlap. METHODS: A retrospective analysis of Papanicolaou stained fine needle aspirate smears from 50 patients with salivary gland neoplasms, with available follow-up histopathology, was performed. The aspirates were categorised in to three neoplastic categories of Milan system for reporting salivary gland cytology (MSRSGC) that is benign neoplasm, salivary gland neoplasm with uncertain malignant potential, and malignant. The smears were subjected to cytomorphometric image analysis using Image Pro Software (version 10). Each nucleus was analysed for 13 parameters including aspect ratio, intensity, diameter, perimeter, roundness, area, Feret diameter, circularity, radii, Fournier description and chromatin texture characteristics such as margination, heterogeneity and clumpiness. The data obtained was compared through relevant statistical methods. RESULTS: The comparative morphometric data obtained for parameters using ANOVA, for the three categories showed statistically significant P values (<0.001). The post hoc test (Games-Howel) test also showed significant P values (<.001). CONCLUSION: Cytomorphometric image analysis is an important tool in diagnosis of salivary gland neoplasms and can improve the diagnostic accuracy for better treatment and improved prognosis. However, more studies with larger sample size may be needed in future for further affirming its role.

Diagnosing obstructive sleep apnea patients with isolated nocturnal hypoventilation and defining obesity hypoventilation syndrome using new European Respiratory Society classification criteria: an Indian perspective.

BACKGROUND: Recently, new classification criteria for obesity hypoventilation syndrome (OHS) have been described. OHS prevalence according to new criteria has not been reported in obstructive sleep apnea (OSA). Prevalence of OHS has not been previously reported from India. METHODS: Retrospective study was carried out in OSA patients for whom both arterial blood gases (ABG) and end-tidal CO2 (etCO2) records were available. OHS was defined according to old and new criteria. Analysis was carried out among various groups: patients without OHS (Group A), patients with sleep hypoventilation but without daytime hypercapnia (Group B) and patients with daytime hypercapnia (Group C). RESULTS: Out of 367 patients with OSA (body mass index, BMI) 31.9 ± 12.27 kg/m2), finally 128 obese OSA patients were included for analysis. Of those, 15 (5.9%, 95% confidence interval (CI) 3.5-9.4) and 45 patients (17.8%, 95% CI 13.4-22.9) fulfilled prevalence of OHS according to old and new criteria, respectively. Continuous positive airway pressure (CPAP) titration failed in 9.6%, 53.3% and 66.7% in Groups A, B, and C, respectively. For all parameters of OSA severity (apnea-hypopnea index (AHI), Nadir O2, T90) and positive airway pressure (PAP) requirements, patients in Group B were in between those in Groups A and C. Statistically significant difference was seen between Group A and Group B, and between Groups A and C, but not between Groups B and C. CONCLUSION: One in six OSA patients and one in three obese OSA patients (BMI >30 kg/m2) have OHS according to new criteria. Since patients with isolated nocturnal hypoventilation were as sick as patients with daytime hypercapnia, screening for sleep hypoventilation should be carried out in all obese OSA patients.