RESUMEN
Background: Areca nut (AN) is one of the addictive substances known to cause deleterious effects on oral cavity as well as on various body organs including liver. But, scanty information is available reporting the adverse effects of AN chewing on the liver. Aim: To study the risk of liver disease in AN habitual based on the relevant published data. Methods: The literature search was performed by an electronic search of the PubMed/Medline, Scopus and Google Scholar databases using proper MESH headings and retrieved the articles published from 1998 to 2021. The eligibility criteria included: Human studies, AN habitual as study participants, use of controls and articles published in English. Data were extracted regarding characteristics of studies, characteristics of AN exposure, effect estimate and outcome of the studies. Results: Total 253 articles were identified from various databases and 15 studies were selected that met the inclusion criteria. Among these, thirteen studies showed an association between AN habit and attenuation of risk of liver disease as determined by relative risk/odds ratio/hazard ratio. Eleven studies described additive effect of AN and HBsAg and/or Anti hepatitis C virus status on development of liver disease. However, two of the studies showed opposite results. The heterogeneity in the study designs, exposure characteristics, outcomes and confounders precluded further meta-analysis. Conclusion: The association between AN chewing and an increased risk of developing liver disease is noted which necessitates the need for AN cessation campaign.
RESUMEN
BACKGROUND AND OBJECTIVES: Heart failure leading to renal dysfunction and vice-versa termed as Cardio-Renal Syndrome(CRS) has now been increasingly identified as a marker of higher morbidity and mortality. Till date, there is limited data available regarding clinical profile, associated risk factors and outcome of CRS in rural population of central India. This study was conducted to elucidate the prevalence, risk factors, and outcome of CRS and its types. METHODS: This was a single-centric, cross-sectional study conducted amongst the patients admitted to medicine wards and ICCU from October 2017 to September 2019. Classification given by RONCO et al. in 2008 was used for classifying CRS patients into various types. Cross-sectional data was used to find the prevalence, risk factors and their inter-relationship with outcome and mortality. STATA software was used for statistical analysis. RESULTS: Out of 96 CRS patients, 47(48.96%) were Type 1, 22 (22.92%) were type 2, 19(19.79%) were type 4 and 3 (3.13% ) were type 3, and 5 (5.21%) were of type 5. Most common risk factor was Hypertension (HTN) found in 46 (47.92%), followed closely by Coronary Artery Disease (CAD) and anaemia. Mortality was seen in 44(45.83%) of CRS patients and it was significantly high. High mortality was common in patients of types 3 and type 5 CRS. Risk factors like HTN, CAD, smoking, reduced glomerular filtration rate, low ejection fraction and sepsis were significantly associated with worse outcomes across all CRS sub-types. INTERPRETATION AND CONCLUSIONS: There is high mortality among CRS. Prevention or optimal management of HTN, CAD and sepsis is required to decrease mortality. There is need for more population based studies for confirming our study findings.
RESUMEN
INTRODUCTION: Despite evidence in support of assessment and treatment of risk factors to prevent cardiovascular disease (CVD) among people with type 2 diabetes mellitus (T2DM), studies have shown gaps in practises at the primary care level. The study was undertaken to find out the prevalence and management of risk factors for CVD in patients with T2DM from rural area India. METHODOLOGY: A crosssectional study was conducted in a tertiary care hospital in rural India. Around 192 persons with T2DM over 35 years of age were interviewed and examined using a structured questionnaire to determine the presence of CVD risk factors, previous assessment and management of these risk factors. RESULTS: The mean age was 58.91 (SD 11.30) years. Tobacco use and harmful consumption of alcohol were reported by 67.7% and 27%, respectively. Nearly 43.8% were doing moderateintensity physical activity, 2.1% were consuming more than 6 servings of green leafy vegetables/fruits per week, 22.9% were overweight and 5.2% were obese. A family history of CVD was present in 12.5%. About 75% of participants were having one or more risk factors for CVD, and a comprehensive CVD risk assessment was done by 15%. The most commonly assessed risk factor was blood pressure (84.3%) and blood sugar (40%). Around 30% were advised for weight reduction and 23.4% were advised to quit tobacco. Dietary counseling and diet plan were prepared for 17 (8.9%) participants. CONCLUSION: Nearly threefourths were receiving treatment for hypertension. The majority of people with T2DM in rural areas had one or more CVD risk factors; however, very few were assessed and treated for CVD risk factors at the primary care level. Patient education and training of the diabetes care providers at the primary care level may be useful for comprehensive CVD risk assessment and treatment to prevent CVD complications in patients of T2DM.
RESUMEN
BACKGROUND: Reaching a correct diagnosis is a challenge for physicians treating any of the 30% to 50% of pulmonary tuberculosis patients who have negative sputum cultures or who present with no sputum. Flexible bronchoscopy acquires special importance for these cases for whom empirical anti-tuberculosis therapy is the only option left. In our study we aimed to assess the diagnostic yield of flexible bronchoscopy in patients, suspected to have tuberculosis, whose sputum smears were negative. METHODOLOGY: In our hospital-based cross-sectional study, 42 patients were enrolled by consecutive sampling. Flexible bronchoscopy and selective bronchial washings were done in all patients. RESULTS: Bronchoscopy lavage smears were positive for M. tuberculosis in 10 (23.8%) patients. Fifteen (35.7%) patients had positive culture. CONCLUSION: Flexible bronchoscopy has an important role in the diagnosis of patients suspected to have tuberculosis, whose sputum smears are negative or who can not produce sputum.