Risk factors for acute myocardial infarction in central India: a case-control study.

BACKGROUND: Atherosclerosis is a multi-factorial disease involving the interplay of genetic and environmental factors. Studies highlighting the public health importance of risk factors like chronic infections causing acute myocardial infarction (AMI) in the Indian context are scarce. This study was undertaken to study the association of socio-demographic and life-style factors with acute myocardial infarction in central India. MATERIALS AND METHODS: The cases and controls were group-matched for age, gender, and socio-economic status. A blinded research associate administered the study questionnaire. We performed an unconditional multiple logistic regression analysis. RESULTS: The case-control study included 265 cases of AMI and 265 controls. The results of final model of logistic regression analysis for risk factors of AMI included 11 risk factors at α = 0.05. They were waist hip ratio, body mass index, stress at home in last 1 year, hypertension, family history of CHD, past history of gingival sepsis, tobacco smoking, raised total serum cholesterol, Chlamydia pneumoniae, Helicobacter pylori and raised C-reactive protein. CONCLUSION: The findings confirm the role of conventional risk factors for cardiac disease and highlight need for research into the association between chronic infections with AMI.

Risk factors for low birth weight in an Indian urban setting: a nested case control study.

This study explores the risk factors for low birth weight (LBW) in an urban Indian setting by using a nested case-control design. Information on potential risk factors was sought from 384 pregnant women attending an antenatal clinic, and they were followed until birth. Based on birth weight, the babies of these women were categorized as cases or controls. Bivariate analyses between each risk factor and birth weight showed an unadjusted significant association (P < .05) for maternal age ≤20 years, antenatal clinic registration after the first trimester, ≤5 antenatal visits, and <80% of the recommended dietary allowance (RDA) for calories and proteins. Multiple logistic regression analysis showed an adjusted significant association for calorie intake <80% RDA (P < .048), low zinc intake (P < .001), and ≤5 antenatal visits (P < .001). This study emphasizes the continuing importance of timely and regular antenatal visits and intake of appropriate amount of calories. The role of zinc as a risk factor for LBW warrants further research.

Results of single-staged rotational osteotomy in a child with congenital proximal radioulnar synostosis: subjective and objective evaluation.

BACKGROUND: For congenital proximal radioulnar synostosis, both conservative and operative treatments have been described. Most of the studies describing surgical interventions are based on subjective evaluation of the forearm function and have used severe degree of forearm pronation as an indication for surgery. This study describes a single-staged rotational osteotomy of the proximal third ulna and distal third radius. The aim of the study was to assess the utility of the described surgical procedure by subjective and objective evaluations of the forearm function. METHODS: Forty-eight children with congenital proximal radioulnar synostosis were evaluated by subjective and objective assessments and were followed up prospectively. Subjective evaluation consisted of a set of 12 questions regarding the basic activities of life. Objective evaluation was made using the Jebsen-Taylor hand-function test and a classification system used by Failla and colleagues for 15 tasks described by Morrey and colleagues. Eleven children were treated conservatively. Thirty-six children underwent a single-staged rotational osteotomy of the proximal third ulna and distal third radius. After surgery, the evaluations were repeated. The mean age at surgery was 8.6±3.7 years, and the mean postoperative follow-up period was 54±13 months. RESULTS: All operated forearms showed a statistically significant improvement in functioning after surgery as per the subjective and objective evaluations. The mean time taken to carry out all activities before surgery was 47.7+10.0 seconds, which significantly reduced to 33.3+6.6 seconds after surgery (P=0.0001) as per the results of the Jebsen-Taylor hand-function test. All good (n=19) and fair (n=11) results were converted to excellent (n=30) after surgery as per the modified Failla classification. There were no neurovascular injuries as compared with other published techniques. Only 1 child had delayed union, and 1 had persistent dorsal angulation at the radial osteotomy site. CONCLUSIONS: For patients with congenital radioulnar synostosis and pronation deformity interfering with function and quality of life, the single-staged rotational osteotomy of the radius and ulna is a good alternative procedure. LEVEL OF EVIDENCE: Level IV--therapeutic.

Effect of indoor air pollution during cooking on peak expiratory flow rate and its association with exposure index in rural women.

Routine exposure to domestic cooking fuels is an important source of indoor air pollution causing deterioration of lung function. We conducted a community based cross-sectional study in 760 non-smoking rural women involved in household cooking with four types of cooking fuels i.e. Biomass, Kerosene stove, Liquid Petroleum Gas (LPG) and Mixed (combination of two and more cooking fuels). Peak Expiratory Flow Rate (PEFR) less than 80% of the predicted was considered as abnormal PEFR. The overall prevalence of abnormal PEFR was found to be 29.1% with greater predominance among biomass fuel users (43.3%) with high risk ratio (1.86) as compared to kerosene (0.63), LPG (0.75) and mixed (0.66) fuel users. However the pair wise comparison of different groups of cooking fuels by Marascuilo procedure reported significant differences within different groups except kerosene--mixed group. The study also demonstrated a negative correlation between observed PEFR and exposure indices in different cooking fuels (r = -0.51). Our results indicate that prolonged exposure to cooking fuels particularly biomass fuels as a source of cooking adversely affects PEFR in nonsmoking rural women.

Prevalence, awareness, control, and associations of arterial hypertension in a rural central India population: the Central India Eye and Medical Study.

BACKGROUND: Because relatively little has been known about the actual prevalence of hypertension in India, particularly for its rural population, we investigated the prevalence of arterial hypertension in a rural Indian population. METHODS: The Central India Eye and Medical Study is a population-based study in a rural Central Indian region. It included 4,711 subjects (ages 30+ years) undergoing an ophthalmic and medical examination. Hypertension was defined as systolic blood pressure > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg, and/or self-reported current treatment for hypertension. RESULTS: Arterial hypertension was found in 1,041 (22.1%) subjects. Its prevalence was associated with higher age (P < 0.001), higher body mass index (P < 0.001), body height (P = 0.001), higher blood hemoglobin levels (P < 0.001), and elevated blood urea concentration (P = 0.008). It was not significantly associated with gender, level of education, family income, kind of daily physical activities, type of diet, and serum concentrations of cholesterol and creatinine. Among the hypertensive study participants (n = 1,041), 208 (20.0%) subjects were aware of their disease. A current antihypertensive treatment was reported by 84 subjects of the 1,041 arterial hypertensive subjects (8.1 +/- 0.9%). Out of the treated subjects, 24 (29%) had abnormally high diastolic blood pressure measurements and 44 (52%) participants had abnormally high systolic blood pressure measurements. CONCLUSIONS: In a rural Central Indian population of ages 30+ years, the prevalence of arterial hypertension was 22.1 +/- 0.6% with an awareness rate of 20% and a treatment rate of 8%. The low awareness and treatment rate may demand increasing public health efforts.