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Abstract Angiotensin II (Ang II) is a hormone and the main effector of the renin-angiotensin system (RAS). This peptide has crucial pathophysiological effects on hypertension, cardiac hypertrophy, endothelial proliferation, inflammation and tissue remodelling through G protein-coupled receptors. The pro-inflammatory role of Ang II has been reported in various inflammatory processes. Obesity is linked to a chronic inflammatory process which in turn is the cause of some of its morbidities. Ang II is related to the comorbidities related to the comorbidities of obesity, which include alterations in the heart, kidney, hypertension and coagulation. In this regard, activation of AT1 receptors by Ang II can induce an inflammatory process mediated by the transcription factor NF-kB, triggering inflammation in various systems that are related to the comorbidities observed in obesity. The aim of this review was to highlight the pro-inflammatory effects of Ang II and the alterations induced by this hormone in various organs and systems in obesity. The search was done since 1990 through Medline, EMBASE and PubMed, using the keywords: angiotensin II; angiotensin II, obesity; angiotensin II, kidney, obesity; angiotensin II, coagulation, obesity; angiotensin II, inflammation, obesity; angiotensin II, adipose tissue, obesity; angiotensin II, hypertension, obesity; angiotensin II, insulin resistance, obesity; angiotensin II, adiponectin, leptin, obesity; angiotensin II, COVID-19, obesity. Angiotensin II through its interaction with its AT1 receptor, can induce alterations in diverse systems that are related to the comorbidities observed in obesity. Therapeutic strategies to decrease the production and action of Ang II could improve the clinical conditions in individuals with obesity.
Resumen La angiotensina II (Ang II) es una hormona y el principal efector del sistema renina-angiotensina (SRA). Este péptido tiene importantes efectos fisiopatológicos en la hipertensión, la hipertrofia cardíaca, la proliferación endotelial, la inflamación y la remodelación tisular a través de receptores acoplados a la proteína G. El papel pro-inflamatorio de la Ang II se ha reportado en diversos procesos inflamatorios. La obesidad está ligada a un proceso inflamatorio crónico que a su vez es causa de algunas de sus morbilidades. Se ha demostrado que la Ang II está relacionada con las comorbilidades de la obesidad, que incluyen alteraciones en el corazón, el riñón, la hipertensión y la coagulación. En este sentido, la activación de los receptores AT1 por la Ang II puede inducir un proceso inflamatorio mediado por el factor de transcripción NFkB desencadenado inflamación en diversos sistemas que se relacionan con las co-morbilidades observadas en la obesidad. El propósito de esta revisión fue destacar el efecto pro-inflamatorio de la Ang II y las alteraciones inducidas por esta hormona en diversos órganos y sistemas en la obesidad. La búsqueda se hizo desde 1990 a través de Medline, EMBASE and PubMed, utilizando las palabras clave: angiotensina II; angiotensina II, obesidad; angiotensina II, riñón, obesidad; angiotensina II, coagulación, obesidad; angiotensina II, inflamación, obesidad; angiotensin II, adipose tissue, obesidad; angiotensin II, hipertensión, obesidad; angiotensin II, resistencia a la insulina, obesidad; angiotensin II, adiponectina, leptina, obesidad; angiotensina II, COVID-19, obesidad. La angiotensina II a través de su interacción con su receptor AT1 puede inducir alteraciones en diversos sistemas que están relacionados con las comorbilidades observadas en la obesidad. Estrategias terapeúticas para disminuir su producción y la acción de la AngII pudieran mejorar las condiciones clínicas en individuos con obesidad.
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Purpose: To evaluate the impact of comprehensive eye examination in identifying the ocular co?morbidities in patients presenting for cataract surgery through the community screening program. Methods: This was a hospital?based retrospective cross?sectional descriptive study in a tertiary eye care institute. Comprehensive eye examination was performed for all patients screened for cataract surgery through the out?reach activities. Patients suspected to have any ocular co?morbidity were revaluated by sub?specialty trained ophthalmologists, and further management was planned. The demographic details of patients, sub?specialty consultation, final diagnosis, and type of the treatment received by these patients were recorded. Results: During the study period, 4022 patients were referred to the base hospital for cataract surgery, of whom 922 (22.9%) needed a specialist opinion. Glaucoma (238) and retinal disorders (232) constituted half (51%) of these referrals. There were 313 (33.9%) patients having co?morbidities because of corneal, oculoplastic, and neuro?ophthalmic conditions. After specialist review, 397 (43.1%) patients underwent only cataract surgery, 55 patients (5.9%) underwent combined surgeries, and 168 (18.2%) patients underwent other procedures. Cataract surgery was not performed in 470 (50.9%) patients, of which 302 were prescribed glasses or managed medically. Conclusion: All patients screened for cataract surgery through out?reach programs require a comprehensive eye examination to identify ocular diseases other than cataract. Provisions must be made for providing alternative or additional treatment in those with various ocular co?morbidities.
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Introduction : disease is very much required for future preparedness. To assess the epidemiological andObjective : clinical profile of cases of COVID 19 Cross sectional descriptive study was carried out at a RuralMethod : Health Training Centre (RHTC). All cases reported in the month of January 2022 were included in the study. The information about the epidemiological and clinical profile was collected from RHTC records by conducting telephonic interview. Total 83 cases were reported. Among them, 43 (54.4%) casesResults : were in age group 20-39 years. Male: Female ratio was 1.37:1. There was one death and patient had ovarian cancer as co-morbidity. Total 71 patients could be contacted for telephonic interview. Fever was most common symptom and was presenting symptom on first day followed by cough/cold and sore throat. None had shortness of breath or chest pain. Hospitalization rate was 5.63% and none required oxygen supplementation or intensive care. Recovery period was 3-5 days. Out of total, 90% cases were fully vaccinated and 95.8% had knowledge of CAB. Diabetes and hypertension were most common co- morbidities and were statistically significantly more in age > 40 years. The COVID-19 cases inConclusions : the beginning of year 2022 had clinical presentation different than the earlier waves. Periodic situational analysis can guide in policy making for handling this pandemic in future.
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Background:High flow nasal cannula is a newer modality of treatment for hypoxemic respiratory failure. Present study is conducted to evaluate demographic characteristics, co-morbidities and outcome parameters of patients on High flow nasal cannula. Material And Methods:In retrospective observational study all patients on High flow nasal canula with covid-19 were evaluated for demographic characteristics and outcome with comorbidities during study period.Result:Maximum number of patients belongs to age group 51-60 years. Highest mortality was in the age group of 61-70 years.Conclusion:The High flow nasal cannula therapy may provide important newer modality and helpful in patients with respiratory failure.
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Introduction: Vaccination against Covid-19 has become the promising strategy in controlling rise in Covid cases. Covishield and Covaxin were the two vaccines initially available in India which have been administered to all those >18years of age. These vaccines exhibit a spectrum of side effects, which may affect vaccination rates. The study was conducted to estimate the frequency of side effects of Covid vaccines in India and their relationship with co-morbidities and prior Covid-19 infection. Methodology: A cross sectional questionnaire-based online survey was conducted for duration of one month among 1800 participants who had received at least one dose of Covid vaccine at KIMS Hospital, Hubballi, Karnataka, selected using systematic random sampling and information about vaccination, comorbidities and covid infection after vaccination was collected. Results: The most common side effects were fever, headache and generalised body ache. The prevalence of infection after complete vaccination with Covishield (4.45%) was higher than Covaxin (1.08%) and difference was statistically significant. The prevalence of side effects and Covid-19 infection after vaccination did not vary with co-morbidities. Conclusion: The side effects reported were not serious and the prevalence was similar in both the vaccines. The prevalence of infection still remains high after vaccination; hence Covid Appropriate Behaviour should be continued.
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Background: Drug interaction (more precisely ‘drug-drug interaction’) refers to modifying the action of one drug by another when administered simultaneously or in quick succession. Chronic Kidney Disease (CKD) patients often require polypharmacy, which puts them at the risk of the developing Drug - Drug Interactions (DDIs) and various adverse reactions. Not all patients taking interacting drugs experience adverse consequences, but it is advisable to take due precautions to avoid mishaps in all cases where interactions are possible. Hence, this study was undertaken to identify the DDIs among the drugs prescribed to CKD patients. Materials and methods: A Cross-sectional study was conducted in the Department of Nephrology. A total of 80 patients with CKD were included. Patients with CKD with other comorbid conditions, CKD patients of either sex above the age group of 18 years were included. LEXICOMP drug interaction software was used for potential DDI (pDDI) identification. Results: Patients mean age was 47.24±14.37 years with male predominance of 72.5 %. A total of 604 drugs were prescribed with a mean of 7.55 ± 2.73. The most common medications prescribed was Amlodipine (6.3%). DDIs were identified in 74 patients. 46 showed 1 to 5 pDDIs, 22 patients showed 6 to 10 p DDIs, 4 patients showed 11 - 15 DDIs, and 2 patients showed 16 to 20 pDDIs. According to the Lexicomp severity classification, 270 were Type C, 57 were Type D & 55 were Type B. Conclusion: The recognition of potential DDI and key combinations of drugs avoids treatment failure situations or minimizes drug toxicity .
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Background: The presence or absence of Intellectual Disability(ID) has been recognized as one of the strongest determinant of outcomes for individuals with Autism Spectrum Disorder(ASD). Behavioural problems which are commonly reported in autism may be related to core features of autism, comorbid diagnoses or symptoms . There is paucity of Indian studies on prevalence of ASD among children diagnosed with ID and also the prevalence of behaviour problems in this population. This study was conducted with the objectives to assess the prevalence of ASD in the intellectually disabled, as well as the associated comorbidity patterns. Methodology: It was a cross sectional study including 122 children with mild/moderate Intellectual Disability between 6 to 18 years. Indian Scale for Assessment of Autism(ISAA), Behaviour Problems Inventory(BPI) was administered and questions were asked to know medical symptoms. Results: Prevalence of co-morbid ASD in children with ID was with 16.39%. Children with ASD had higher behavioural problems (p=0.001), higher medical complaints like GI symptoms (constipation p=0.001, bloating p=0.03, abdominal pain p=0.03) and seizure (p=0.002). Behaviour problems were higher in children with more severe autism scores. Conclusion: There is a notable prevalence of ASD in children with ID. These children tend to have higher behavioural problems and co-morbid medical issues which needs clinical attention for better overall management of these children.
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RESUMEN Introducción: desde los finales del año pasado en Wuhan, se informó de una neumonía de etiología desconocida, que llevó a la Organización Mundial de la Salud a declarar la infección por SARS-CoV-2, como una emergencia sanitaria denominándola como enfermedad por coronavirus 2019 (COVID-19). En Cuba se confeccionó un programa de enfrentamiento, en el cual la atención hospitalaria, siguió un riguroso protocolo de atención a pacientes positivos de la COVID-19, en áreas de cuidados mínimos, intensivos o progresivos. Objetivo: caracterizar clínica/epidemiológica pacientes positivos de la COVID-19, ingresados en el Hospital "Amalia Simoni". Materiales y métodos: se realizó un estudio descriptivo, transversal de 1 066 ingresos en el Hospital "Amalia Simoni", de marzo-mayo del 2020. Se revisaron historias clínicas y se obtuvo: edad, sexo, procedencia, sintomatología, comorbilidades y evolución epidemiológica. Datos que se evaluaron mediante estadísticas descriptivas. Resultados: se halló un predominio de edad media, sin diferencias de sexo, predominaron los casos de la ciudad de Camagüey y de los municipios con mayor urbanización. Prevalecieron la tos y la fiebre, además de la mitad de los casos sin comorbilidades, con solo un pequeño porcentaje de casos confirmados. Conclusiones: con un enfoque basado en la medicina preventiva en los casos estudiados, predominó la edad media, de procedencia de áreas urbanizadas con mayor población y aglomeraciones sociales. Se destacó que el ingreso precoz, basada en la pesquisa de la Atención Primaria logró disminuir los casos confirmados a un pequeño porcentaje, al igual que los graves y un solo fallecido (AU).
ABSTRACT Introduction: from the end of the last year in Wuhan, China, it was informed an unknown etiology pneumonia leading the World Health Organization to declare the infection with SARS-CoV-2 a sanitary emergency naming it coronavirus disease 2019 (Covid-19). A confrontation program was elaborated in Cuba, in which hospital care followed a rigorous protocol to take care to Covid-19-positive patients in areas of minimal, intensive and progressive care. Objective: to clinically/epidemiologically characterize Covid-19-positive patients admitted in the Hospital "Amalia Simoni". Materials and methods: a cross-sectional, descriptive study was carried out in 1 066 patients admitted in the Hospital "Amalia Simoni" in the period March-May 2020. Clinical records were reviewed and data gathered were age, sex, origin, symptomatology, co-morbidities and epidemiological evolution, data obtained through descriptive statistics. Results: it was found the predominance of medium age, without sex differences; the cases of patients from the city of Camaguey and from the municipalities with biggest urbanization predominated. Cough and fever prevailed; half of cases did not have comorbidities, and only a little percent of cases was confirmed. Conclusions: with an approach based in preventive medicine, medium age, and provenance from urban areas with bigger population and social concentrations predominated in the studied cases. It was showed that precocious admission, based on the Primary Health Care screening, succeeded in diminish confirmed cases to a little percent, as diminished the seriously ill ones; only one patient died (AU).
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Humans , Male , Female , Patients , Coronavirus Infections/epidemiology , Critical Pathways/standards , Patient Isolation/methods , Signs and Symptoms , Clinical Evolution , Sensitivity and Specificity , Coronavirus Infections/complications , Coronavirus Infections/diagnosisABSTRACT
Background: To study the demography, disease distribution and co morbid conditions, complications and mortality among elderly patients undergoing operation in general surgical wards.Methods: A prospective observational study was conducted among elderly patients of age ≥60 years admitted in General Surgery wards at our institute for a period of a year. Results: A total of 137 patients were recruited in this study. Out of them 62.04% were men and 37.96% were women. Most common system involved was hepatobiliary with a total of 38 cases (27.7%), most common surgical disease in our study was hernias (27%) and gallstone disease (25%). About 55.5% of our study population had co morbid medical conditions. Hypertension was the most common co morbidity (38%) in our study. Out of 137 cases, 115 cases were elective cases and 22 were emergency cases, operated in emergency settings. About 16.7% of the study population had surgical complications. Post-operative seroma formation at the surgical site was the most common complication. About 7 cases were succumbed to death and mortality rate was about 5.1% in our study population.Conclusion: Prevalence of medical co morbidities is higher in elderly population. Out of them, hypertension and diabetes mellitus are the most common co morbid conditions. Most common indications for elective surgery in our study are hernias and gallstone disease. Early elective surgical intervention is preferred in elderly population when presented, as age, co morbidities and emergency settings increase risk of perioperative mortality.
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Human existence and their health rely on their intellectual interactions with ecosystem which eventually accompanies brilliant technological innovations. At par with the technological progress, humans also have been facing several intimidating communicable and non-communicable diseases. Amidst such disease threats, humans have discovered multiple ways to uplift the average life span all over the globe but still not up to the fitness benchmarks of healthy ageing trajectory. COVID-19 has specifically revealed the fragility of humans as they continue succumbing exponentially to the interactions of this communicable disease with their existing non-communicable diseases like hypertension, cardiac pathology and diabetes. In human evolution, the COVID-19 pandemic could be the most perfect synapse or intersection of non-communicable diseases with this transmissible disease leading to a situation that can be even named as “Global Medical Stampede” characterized by sudden increase in the number of patients requiring life-saving procedures for which there is lack of adequate manpower and technological support in health care system. This whole chaotic scenario could easily trigger acute psychological and physiological stress primarily caused by fear among the public favoring the frightening consequences of the pandemic. This article aims to suggest refinement in public health paradigms to enable preparations to face such disease threats from the immediate future without further procrastination.
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Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria spread by droplet infection.According to global TB report 2017, there were approximately 28 lakhs cases of TB in India accounting a quarter of the world TB cases. Today, it is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment and the second largest in terms of population coverage. The objective of this study is to assess the socio-demographic profile of the patients attending revised national TB control programme (RNTCP) clinic, to determine the nature of disease, its co-morbidities, seasonal variability and treatment profile of the patients attending the RNTCP clinic during this study period.Methods: This was a retrospective record-based study conducted in RNTCP clinic of KPC Medical College and Hospital, Kolkata. Details of all the 684 patients who were enrolled under RNTCP from the year 2014 to 2018 were collected from RNTCP records. Data was analyzed using suitable software.Results: 684 cases were registered and treated under directly observed treatment, short-course (DOTS) during the study period with 41% completing treatment. 84.3% were new TB cases. 23.61% were sputum smear positive. Males (67.25%) contributed to more in cases. Maximum patients visited during March to June. 74.87% of the total patients were diagnosed with pulmonary TB. Pleural effusion was the commonest form of extrapulmonary TB (42.75%).Conclusions: The number of TB cases showed a decreasing trend over the years. Males contributed to a greater number of cases with majority being contributed by the age group 21-30 years.
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Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.
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Background: Alcohol use is associated with serious public health problems thereby raising the global morbidity and mortality. The main aim of this study is to estimate the prevalence of alcoholism and its co morbidity pattern among urban adult population in Salem district, Tamil Nadu.Methods: A community based cross-sectional study was carried out among urban adult population in Salem district involving 493 participants. Convenient sampling method was used. Informed consent was obtained from each participant and information was collected by using a predesigned structured questionnaire. Microsoft Excel 2007 was used for data entry and SPSS version 24 was used for data analysis.Results: It was found from the study that the prevalence of alcoholism was high. Alcohol use in any form was found in 38% of the study participants. 8% of the participants confessed that alcohol is an eye opener to them. 6% of the participants lost their job and 15% of the participants were hospitalised due to alcohol.Conclusions: The study showed higher prevalence of alcohol use among urban adult population in Salem district. Awareness about the ill effects of alcoholism among the population and necessary rehabilitation will help to reduce alcoholism consumption and its related disorders.
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Background: Cerebral palsy is the most common aetiology for motor dysfunction among children worldwide. It is associated with range of co-morbid conditions that affects the quality of life. Cerebral palsy has been studied extensively in western countries and there are only few articles available on epidemiological information in developing countries and low resource settings. This study focuses on the aetiology, risk factors, types and co-morbidities in cerebral palsy.Methods: Cerebral palsy children attending tertiary care hospital were prospectively recruited into the study. The study was conducted during January 2017 to July 2018. The cross-sectional study included complete prenatal, natal and postnatal history of the participants, BERA and Ophthalmological examinations were done.Results: One hundred and fifty children with cerebral palsy were enrolled. The mean age of participants were 36'30 months.' Male to female ratio was 2.19:1. The most common maternal risk factor among study participants was consanguinity in marriage (23.33%). 16% had prolonged labour and 10% had toxaemia during pregnancy. 47% of the children were born by institutional normal vaginal delivery. The most common neonatal risk factor was Birth Asphyxia (23%), low birth weight (20%) and neonatal sepsis (21%). 122 had spastic type of cerebral palsy. The most common morbidity associated with cerebral palsy was Gastro intestinal disturbances in 61% of the participants.Conclusions: History of prolonged labour and birth asphyxia were risk factors for cerebral palsy. Spastic CP is the most common type. Malnutrition, Gross Motor delay, Seizures, Mental retardation were the most common morbidities associated with CP.
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Introduction: COPD is a major cause of morbidity andmortality worldwide Besides lungs it has systemic effects,co morbidities. These co morbidities increase the risk ofexacerbation, reduce health status and increase risk ofmortality. The primary objective of this study was to assesthe various co morbidities in COPD patients, to study thedifference in proportion of co morbidities in smokers ascompared to the non-smokers and to study the proportion ofvarious co morbidities according to GOLD stageMaterial and methods: We studied 55 consecutive COPDpatients who presented to the department of pulmonarymedicine, Goa Medical College from August 2016 to July2017.Results: Out of the 55 patients included in the study 34(61.8%) were males and 21(31.8%) were females, age (meanand SD) 67.32±9.46, FEV1% (mean and SD) 47.45±12.78,FEV1/FVC% (mean and SD) 57.05±9.11, 36(65.4%) weresmokers with pack /year (mean and SD) 26.08±17.55, and19(34.5%) had biomass exposure with Biomass exposureindex (mean and SD)104.54±71.05 and Hb (mean and SD)was 12.83±2.19. The most frequent co morbidties werehypertension 54.5% (30 cases), followed by psychologicaldisturbance like depression 43.6% (24 cases). Percentage ofco morbidities were higher in the COPD patients exposed totobacco smoke as compared to biomass smoke. Percentage ofco morbidities were higher in the very severe stage of COPDas compared to the other stages of COPD.Conclusion: We recommend as a general practice to assesco morbidities in all COPD patients and vise versa as the comorbidities play a important role in exacerbation, reducinghealth status and increasing risk of mortality
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Background: Chronic pulmonary obstructive disease (COPD) has been responsible for the decreased quality of life as well as increased morbidity and mortality. Globally it has been estimated that nearly three million die yearly due to COPD and more likely to occupy the third place of mortality by 2030. The objective of the present endeavour was to study clinical profile of patients with chronic pulmonary obstructive disease at a tertiary care centre.Methods: A hospital based cross sectional study was carried out among 200 cases of COPD. Their detailed history, thorough clinical examination and parameters like hemoglobin, serum creatinine, protein etc were investigated. The presence of co-morbidities was noted.Results: As the age increased the prevalence of the COPD increased and highest was found out to be in the age group of above 60 years of age. Males were more affected with COPD as compared with females. The male to female ratio was found out to be 2.4:1. The smokers were more compared to the non smokers. The prevalence of smoking among COPD was noted to be 66% compared to 34% as non smokers. Least proportion of patients of the COPD had fever i.e. in 22% of the cases. Cough was found in 83% of the cases. Breathlessness was found out to be in 98% of the cases. 15% of the cases of the COPD had diabetes only as the co-morbidity along with COPD and no other co-morbidity.Conclusions: Breathlessness was the most common symptom at presentation and diabetes and hypertension were the most common co-morbidities found.
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@#Transgender is a complex state of bio-psycho-social dimension of human sexuality. It encompasses cognitive-emotional-behavior component that makes the person unique in his or her sexual expression. Transgender tend to use cross-sex hormone in order to eradicate their secondary sexual characteristics and to facilitate the shift to their experienced gender. The common masculinising sex hormone use, i.e. Female to Male Treatment Options (FMTO) is testosterone and for feminising hormone i.e. Male to Female Treatment Options (MFTO) is a combination of estrogen with anti-androgen, respectively. Cross-sex hormone, i.e. FMTO, or MFTO has biological and psychological influences on the transgender individuals. Nevertheless, cross-sex hormone may also pose a range of side effect profiles, varies from the biological to psychosocial impact. The psychological impact can be paramount until it causes severe mental-health problems and even suicide. Numerous ranges of bio-psycho-social influence of cross-sex hormone were highlighted in this review as fundamental core knowledge in the art to know practice when dealing with the treatment options. In psychiatry, the change in the biological appearance may have great influence in the transgender individual, especially in the context of psychosocial and cultural perspective
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ABSTRACTBackground: Stroke is a leading cause of death worldwide these days. It is one of the major public health challenges, not only for neuropharmacology but the society in general. This study was conducted mainly to assess the prescribing pattern of drugs in stroke patients.Methods: A retrospective study was conducted in the department of medicine at BRIMS teaching hospital over a period of 3 months. 40 Patients were included in this study based on the inclusion and exclusion criteria. Pharmacological therapy prescribed was analysed to determine the pattern of prescription of drugs.Results: The incidence of stroke was higher in males as compared to females. Hypertension, smoking, and alcoholism were found to be the major risk factors for stroke. The major co-morbidities identified were hypertension and diabetes mellitus. In study of 40 patients 78% were identified as Ischemic stroke patients and 22% suffered Hemorrhagic stroke. The current prescribing trends were antihypertensive (35%), followed by antiplatelets (25%), statins (10%), antidiabetics (10%), antibiotics (11%) and nootropics (5%).Conclusions: In order to promote the quality use of drugs, the prescribing pattern of drugs should be based on severity of stroke, associated co?morbid conditions, and currently available evidences.
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@#Objective: The objective of this study is to determine the frequency and correlates of insomnia among elderly patients presenting to family medicine clinics at an academic center in Karachi, Pakistan. Study design: This is a cross-sectional study. Place and duration of study: The study was conducted at the Outpatient Family Medicine Clinics at Aga Khan University Hospital between February 2013 and June 2013. Methodology: Patients 60 years old and above were recruited (n=152) through non- probability consecutive sampling. Information was collected on a pretested structured questionnaire on demographics, insomnia symptoms, medical co-morbidities, lifestyle factors and sleep disorders. Data was analyzed on SPSS 19. Proportions and the Chi-Square test were used in the analyses, along with binary logistic regression. Results: The mean age of the participants was 65.68 years, and 38.80% of the participants were male and 61.20% were female. The prevalence of insomnia was 42.1%. It was more common in women than in men (64.10% vs. 35.9%). Increasing age [ORadj: 4.54; 95%CI: 1.85-11.17], being divorced/widowed [ORadj: 10.26; 95%CI: 2.79- 37.73] and having an average household income of over Rs.50, 000, were significantly related to insomnia. The other factors associated with insomnia were Gastro Esophageal Reflux Disease [ORadj: 4.30; 95% CI: 1.67-11.04], depression [ORadj: 2.88, 95% CI: 1.13-7.33], caffeine consumption [ORadj: 6.50; 95% CI: 2.27-18.57], and cigarette smoking close to bed time [ORadj: 4.78; 95% CI: 0.88-25.90]. Conclusion: The study showed that older adults with multiple diseases were at high risk of insomnia. Certain life style practices enhanced the risk; hence, physicians should incorporate sleep history and tailor treatment to target both insomnia and related factors to optimize quality of life.
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ABSTRACT The aim of this study was to compare the predictions of Framingham cardiovascular (CV) risk score (FRS) and the American College of Cardiology/American Heart Association (ACC/AHA) risk score in an HIV outpatient clinic in the city of Vitoria, Espirito Santo, Brazil. In a cross-sectional study 341 HIV infected patients over 40 years old consecutively recruited were interviewed. Cohen's kappa coefficient was used to assess agreement between the two algorithms. 61.3% were stratified as low risk by Framingham score, compared with 54% by ACC/AHA score (Spearman correlation 0.845; p < 0.000). Only 26.1% were classified as cardiovascular high risk by Framingham compared to 46% by ACC/AHA score (Kappa = 0.745; p < 0.039). Only one out of eight patients had cardiovascular high risk by Framingham at the time of a myocardial infarction event registered up to five years before the study period. Both cardiovascular risk scores but especially Framingham underestimated high-risk patients in this HIV-infected population.