Profile of Non-communicable disease risk factors among nurses in a tertiary care hospital in South India.

PURPOSE: The work nature of nurses and the associated lifestyle changes put them at high risk of developing non-communicable diseases (NCDs). This study was conducted to estimate the prevalence of NCD risk factors among nurses working in a tertiary care hospital in Puducherry and to determine the associated factors among nurses. METHODS: We conducted a cross-sectional study among all nurses (N=1217) in the tertiary care hospital aged between 21 and 60 from May 2019 to April 2020. We assessed NCDs behavioral, physical and biochemical risk factors using a self-administered questionnaire. The adjusted prevalence ratio was calculated using a generalized linear regression model to determine factors associated with NCD risk factors. RESULTS: The response rate was 99% (1217/1229), and 77.5 % of the participants were women. Current tobacco use, and alcohol consumption were 1.5% (95% CI: 0.8-2.2) and 2.9% (95% CI: 2-3.9) respectively with significantly higher prevalence among men. Overweight or Obesity (BMI >23 kg/m2) was 77.7%, with a significantly higher prevalence among those aged ≥30 and married. Prevalence of hypertension was 14.4 % (95% CI: 12.5-16.4), and diabetes mellitus was 11.5 % (95% CI: 9.7-13.6) were significantly higher among those aged ≥50 years. One-third of nurses, 34.3% (95% CI: 31.6-37.1), had hypercholesterolemia, significantly higher among men. CONCLUSION: We found a high prevalence of various NCD risk factors among the nurses. We highlight the urgent need for initiating health promotion interventions, especially to improve intake of healthy diet and physical activity among nurses aged ≥30 years.

Metabolic Syndrome and Its Associated Factors Among Faculty Members in a Tertiary Care Teaching Hospital, Puducherry: A Cross-Sectional Analytical Study.

Background: Settings-based approach has received lot of attention under WHO renewed strategy of health promotion. It advocates regular screening/health check-ups of employees to maintain a healthy workplace. This study aimed to assess prevalence of metabolic syndrome (MetS) among faculty members and its association with selected sociodemographic, behavioral and biochemical parameters, and to determine the 10-year fatal or nonfatal cardiovascular risk using WHO-ISH risk chart. Methodology: A cross-sectional study was conducted among 252 teaching faculty members using standardized international protocols to measure behavioral risk factors (smoking, alcohol consumption, diet pattern, physical activity, sleep, and stress), physical characteristics (weight, height, waist and hip circumferences, and blood pressure), and biochemical parameters (fasting glucose and lipid profile). Risk factor profiling was done using WHO/ISH risk prediction chart. Results: Among 252 participants (males: 172 and females: 80), 58 (24.1%) were with MetS. Prevalence was higher in males (24.6%) than females (22.6%). The younger doctors (≤40 years) had lesser prevalence of MetS compared with the elderly (>40 years) doctors (20.3% vs. 26%). Age and diet pattern were found to be independently associated with MetS. The risk of having a cardiovascular event in 10 years was <5% (low risk) for 87.5% of study participants. Conclusion: Although we included doctors who are probably the most health-conscious population, we have found that one in four have a chance of having MetS. There is a need for periodic screening program and lifestyle modification strategies to control the burden of MetS among doctors.

Transarterial chemoembolization in patients with hepatocellular carcinoma beyond Barcelona-Clinic Liver Cancer- B and portal vein tumor thrombosis: Experience from a tertiary care center.

Background: Transarterial chemoembolization (TACE) is the preferred treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) without portal vein tumor thrombosis (PVTT). However, select patients with advanced HCC and with PVTT have shown improved survival with TACE. This study was undertaken to evaluate the outcome of TACE in patients with HCC beyond Barcelona-Clinic Liver Cancer- B (BCLC - B) and those with HCC and PVTT. Methods: Patients with unresectable HCC, subjected to TACE were included. HCC patients with PVTT involving main portal vein and, poor performance status were excluded from the study. Patients were stratified according to performance status, alpha feto protein (AFP) values, and up-to-seven criteria. Individually and using various combinations, the influence of these variables on survival was also estimated. Results: A total of 50 patients were included in the study. PVTT was present in 12 patients. Clinically, significant liver failure was observed in two patients. The average overall survival of patients beyond BCLC-B following TACE was 13 months. Survival was not influenced by tumor invasion into the portal vein. Patients with higher AFP levels had comparable survival provided their tumor load was satisfying up-to-seven criteria. Conclusion: We conclude that TACE could improve survival in selective HCC patients beyond BCLC-B and with PVTT not extending to the main portal vein.

Ebstein's anomaly during pregnancy: experience from a tertiary care centre - a case series and review of literature.

Pregnancy complicated with uncorrected Ebstein's anomaly is uncommon and may pose a serious threat to maternal and foetal life in the clinical setting of altered hemodynamics of pregnancy. Data of eight pregnancies in four women with Ebstein's anomaly who delivered in a tertiary care institute was analysed. Among the four women, one had associated atrial septal defect, one had pulmonary hypertension and three had right bundle branch block. There were two miscarriages and six successful pregnancies resulting in live births. Three of the pregnancies were delivered by caesarean section. There was one pregnancy complicated by severe preeclampsia, no preterm births or maternal cardiac complications. There was one neonate with congenital ostium secundum atrial septal defect. All patients were managed by a multidisciplinary team involving Obstetrician, Cardiologist, Anaesthesiologist and Neonatologist.IMPACT STATEMENTWhat is already known on this subject? Ebstein's anomaly is a rare congenital anomaly with apical displacement of the septal tricuspid leaflet in association with leaflet dysplasia. It may cause varied presentation in pregnancy depending on the severity of the lesion.What do the results of this study add? Ebstein's anomaly may become symptomatic for the first-time during pregnancy. Patients with NYHA class II symptoms and no cyanosis generally tolerate pregnancy well. Miscarriages and intrauterine growth restriction may occur in the presence of this condition. Vaginal delivery is advised and caesarean is done only for obstetric indications.What are the implications of these findings for clinical practise and/or future research? The management of pregnancy with uncorrected Ebstein's anomaly is highly challenging especially in a low resource setting and requires tertiary centre care. Multidisciplinary team involvement can help to improve the outcomes in such pregnancies.

Vascular endothelial growth factor (VEGF) gene polymorphisms (rs699947, rs833061, and rs2010963) and psoriatic risk in South Indian Tamils.

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin. Vascular endothelial growth factor (VEGF), a pro-angiogenic factor, is involved in the pathogenesis of psoriasis. Being highly polymorphic, several SNPs of VEGF have been reported to be associated with increased risk of psoriasis. OBJECTIVES: We determined the association of VEGF gene polymorphisms with risk of psoriasis in South Indian Tamils. METHODS: 300 cases of psoriasis and 300 controls were recruited in this case-control study. Genotyping of SNPs of VEGF gene was done using Taqman 5' allele discrimination assay. Estimation of VEGF levels in plasma was done by ELISA. RESULTS: VEGF (rs2010963) polymorphism and the CTC haplotype were found to confer an increased risk of psoriasis. However, two other VEGF SNPs, rs833061, and rs699947, showed no association with psoriasis susceptibility. VEGF levels were higher in patients with psoriasis, as compared with controls and significantly correlated with disease severity. CONCLUSIONS: Our results indicate that VEGF (rs2010963) polymorphism and CTC haplotype of the VEGF SNPs (rs699947, rs833061, and rs2010963) confer an increased risk of psoriasis in the South Indian Tamil population. Plasma VEGF levels are higher in patients with psoriasis, as compared with controls and are significantly correlated with disease severity.

Balloon valvuloplasty in rheumatic aortic valve stenosis: immediate and long-term results.

To study the immediate and long-term results of balloon aortic valvuloplasty (BAV) in a large cohort of patients with rheumatic valvular aortic stenosis. Single tertiary care center retrospective data analysis of immediate and long-term outcomes in patients following BAV from 2000 to 2008. Ninety-two patients with rheumatic aortic stenosis (AS) were studied who underwent BAV. Mean age of patients was 21.7 years (95 % CI 14.3-28.9) with mean follow-up period of 5.7 years (±SD 1.3). Intervention resulted in successful BAV (more than 50 % reduction in baseline gradient) in 79 (85.9 %) subjects (Group A) and partially successful BPV (<50 % reduction in baseline gradient) in 8 (8.7 %) subjects (Group B). BAV failed in 5 (5.4 %) subjects (Group C). Concomitant balloon mitral valvuloplasty was done in 23/92 cases. Mean left ventricular systolic pressure decreased from 165.6 (95 % CI 142.7-196.3) to 110.9 mmHg (95 % CI 92.1-129.6), (P < 0.001) and mean aortic valve (AV) gradient from 50.7 (95 % CI 35.12-66.22) to 27.2 mmHg (95 % CI 25.83-31.23), (P < 0.001). The mean change in ejection fraction and mean AV gradient were significantly different between success (Groups A and B) and failure groups (P < 0.001). Different grades of aortic regurgitation were noted in 32 (34.78 %) patients post BAV (severe regurgitation in 2.18 %). Anova post hoc analysis showed sustained gradient reductions at 1- and 5-year follow-up (P > 0.05). The need for surgery was much lower in Group A (2.5 %) compared to Group B (50 %) and C (100 %). BAV is an effective treatment strategy in dominant AS in multi valvular rheumatic disease situations. Combined aortic and mitral valvuloplasty was performed in one-fourth of study patients.

Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects.

BACKGROUND: Very few published data is available on the outcomes of balloon assisted techniques (BATs) for trans catheter closure (TCC) of very large (Defined as ≥35 mm size) ostium secundum atrial septal defect (ASD). OBJECTIVE: To study the utility of BAT as against conventional techniques (CT) in TCC of very large ostium secundum ASD (≥35 mm) over the past 5-year period and to find out the association of different morphological features of the defects in relation to TCC outcomes. STUDY DESIGN AND METHODS: Descriptive single center retrospective study of patients with very large ostium secundum ASD (≥35 mm size) who were subjected to TCC. RESULTS: Thirty-three out of 36 patients with ≥35 mm ASD and complex morphological features underwent successful TCC. The study patients had high prevalence of absent aortic and posterior rims with posterior mal-alignment of the septum. BAT was successful in 28/31 (90.3%) patients while CT had a success rate of 16%. The mean trans-esophageal echocardiography (TEE) ASD size with BAT success 37 (SD 1.3) mm and CT failure 36.2 (SD 1.1) mm was not different (P=0.06). On univariate analysis of different morphological features, posterior mal alignment of the septum was associated failure of CT (P=0.01). There was no urgent referral for surgery and patients did well on follow up. CONCLUSIONS: Balloon assisted device closure of (≥35 mm) ASD had 90% success rate. BAT helps in controlled delivery and device alignment in very large ASD with posterior malalignment of the septum and is often helpful when CT fails.

Balloon pulmonary valvuloplasty in adults: immediate and long-term outcomes.

BACKGROUND AND AIM OF THE STUDY: The study aim was to determine the immediate and long-term outcomes of balloon pulmonary valvuloplasty (BPV) in a large cohort of adult patients (aged ≥ 18 years) with congenital valvular pulmonic stenosis. METHODS: A retrospective data analysis was conducted of the immediate and long-term outcomes of adult patients who had undergone BPV between 2000 and 2012 at a single tertiary care center. RESULTS: A total of 132 patients (mean age 27.7 years; 95% CI 21.12-34.76) underwent BPV, with a mean follow up period of 5.7 years (95% CI 4.37-6.98). Intervention resulted in successful BPV (> 50% reduction in baseline gradient) in 124 patients (94%), and a partially successful BPV (20-50% reduction in baseline gradient) in eight patients (6%). The mean right ventricular (RV) systolic pressure was decreased from 90.6 mmHg (95% CI 84.90-96.33) to 50.9 mmHg (95% CI 47.17-54.61) (p < 0.001), and the pulmonary valve (PV) gradient was reduced from 70.7 mmHg (95% CI 65.12-76.22) to 29.0 mmHg (95% CI 25.83-32.23) (p < 0.001). The mean percentage difference in PV gradient in both genders was 60.23% in males and 57.44% in females (95% CI 55.33-65.12 and 55.32-61.56, respectively) (p > 0.05). Pulmonary valve regurgitation was reported in 17.4% of patients, and was not related to either successful outcome or balloon size. The gradient reductions were maintained after five and 10 years of follow up. Two patients (1.5%) developed restenosis that required repeat BPV. There was no referral for urgent surgery. CONCLUSION: BPV in adults produced excellent long-term clinical results, there being no gender-related difference in outcome. In addition, the need for reintervention was very low.