Ten-Year Risk for Developing Cardiovascular Disease Among Older Adults and Elderly in India: A Secondary Analysis of Wave-1 of Longitudinal Aging Study in India.

Background Cardiovascular disease (CVD) risk stratification is recommended by the World Health Organization (WHO) for effective CVD management in primary healthcare settings. Using the 2019 updated WHO CVD risk charts, we estimated the 10-year risk for developing fatal and non-fatal CVD among participants of the Longitudinal Aging Study in India (LASI). Methods We conducted secondary data analysis using the Wave-1 dataset of LASI. Analysis was performed in Stata software (version 14.1; StataCorp LLC, College Station, Texas) after applying sample weights. Ten-year CVD risk was estimated using a non-laboratory-based CVD risk chart. Logistic regression analysis was performed to determine the association between socio-demographic characteristics and 10% or more 10-year CVD risk. Results The weighted prevalence of 10% or more 10-year CVD risk was 24.70% (95% CI: 23.94%-25.47%). Participants who were currently working, living alone, and widowed had 3.63, 1.42, and 1.59 times increased odds of having a high 10-year CVD risk, respectively, after adjusting for other variables. Conclusion About a quarter of older adults and the elderly population in India have a 10-year risk for a fatal or non-fatal cardiovascular event of 10% or more, as estimated using a non-laboratory based chart.

Review of Primary Care Treatment Protocols for Hypertension in Various States of India.

SUMMARY: Over the past few decades, hypertension (HTN) has affected both young and old people. The public health problem has an enormous economic impact on societies as well. The present review aimed to understand and compare the differences from the available literature on HTN treatment at the primary care level in various states and at the national level in India. We reviewed the latest international, national, and state guidelines/protocols available for the treatment of HTN. In addition, we also searched the PubMed database with relevant Medical Subject Headings terms and included the articles published in the last 5 years. A total of 204 articles were screened and finally, eligible 5 articles were included in the review. International guidelines preferred thiazide diuretics as a drug of choice. While the state protocols and national guidelines preferred calcium channel blockers, followed by angiotensin receptor blockers as the drug of choice. All these guidelines focused on low-dose monotherapy. These guidelines also summarized additional drugs required in case of comorbid conditions. However, the new Essential Medicine List published by the World Health Organization prefers low-dose fixed-drug combination (two-drug regimen) at the primary care level for treatment of HTN. There was not much cost difference between monotherapy and fixed-drug regimens based on the published studies. With due rise in HTN cases, the standardized protocol is ubiquitously needed for better application, comparison, and streamline of the program. Fixed-drug combination therapy can be considered for better control rates among hypertensives by improving adherence and efficacy.

Nutritional Status among Patients with Chronic Hepatitis C in the North-Eastern Part of India: A Cross-Sectional Study from the Tribal Belt of India.

Malnutrition is very common in liver disease patients. The nutrition status of chronic hepatitis C infected patients was assessed in those with both compensated and decompensated liver disease. A prospective non-interventional observational study was conducted in a tertiary care hospital among patients attending the liver clinic under medicine Outpatient Department (OPD), with follow-up till six months since recruitment. A total number of 100 recruited eligible patients was divided into two groups of 50 patients each, one comprised of subjects with decompensated liver disease and the other one with compensated liver disease. Out of the 100 participants, 85% were males, with the majority of them being aged between 41 and 50 years, and underweight. At every visit, low mean values in triceps thickness and mid-arm circumference were observed among patients with decompensated liver disease compared to those with compensated liver disease, which had a significant difference statistically. The clinical symptoms and severe malnutrition were found to be higher and significantly statistically associated with the decompensated liver disease patients.

Effectiveness of Intravenous Iron Sucrose Therapy in Routine Antenatal Care for the Treatment of Moderate to Severe Anemia Among Pregnant Women Attending a Secondary Care Hospital in North India: A Retrospective Analysis.

INTRODUCTION: Anemia during pregnancy is an important public health problem and is associated with a number of maternal and fetal complications. Intravenous iron sucrose (IVIS) has been reported to be safe and efficacious in raising the hemoglobin (Hb) level among pregnant women. However, most of the studies were conducted in controlled research settings, and there is a paucity of data on the effectiveness when IVIS is given as routine therapy in public health facilities. The objective of this study was to estimate the change in mean Hb level four weeks after the last dose of IVIS infusion in pregnant women with moderate to severe anemia in a public healthcare setting. METHODS: Records of pregnant women having moderate anemia (Hb level: 7.0-9.9 gm/dL), who received IVIS in calculated dose during routine antenatal care between 1 January 2018 and 31 July 2018, were reviewed. Data were analyzed using STATA version 13 software (StataCorp LLC, College Station, TX). Hb levels before the start of the therapy (baseline) and four weeks after the last infusion (endline) were compared. A value of p < 0.05 was considered statistically significant. RESULTS: The mean (±SD) Hb level increased from 8.5 (±0.88) gm/dL at baseline to 10.3 (±1.24) gm/dL four weeks after the last dose of IVIS infusion. The mean (±SD) increase in Hb level was 1.7 (±1.29) gm/dL (95% CI: 1.57, 1.87). The change from moderate and severe anemia to normal Hb levels was observed in 28.4% and 28.6% of women, respectively. CONCLUSION: IVIS therapy is effective in improving Hb levels when given as routine therapy in a secondary level public healthcare facility.

Prevalence of Anemia Among Adolescent Girls Residing in Rural Haryana: A Community-Based Cross-Sectional Study.

Background Anemia continues to be a major public health problem in India despite multiple initiatives to address it among various vulnerable groups including adolescents. Aim This study was conducted to assess the prevalence of anemia among rural adolescent girls who had attained menarche. Methods The community-based cross-sectional study was conducted in 28 villages of Ballabgarh Block of district Faridabad, Haryana. From the computerized Health Management Information System data (HMIS), a random list of 363 adolescent girls was generated. Adolescent girls who had attained menarche were included in the study. Hemoglobin level was measured for all the consented or assented participants using a digital hemoglobinometer (HemoCue201+ photometer, HemoCue AB, Angelholm, Sweden). Results A total of 272 participants were enrolled in the study. Mean (SD) age at menarche was 13.2 (1.2) years. Prevalence of anemia among adolescent girls who had attained menarche was observed to be 71.7% (95% CI: 66.3 - 77.1) as per the WHO classification. Among the 195 anemic adolescent girls, severe, moderate, and mild anemia was observed in 4.8%, 41.2%, and 25.7%, respectively. In multivariable analysis, after adjusting for the age, the mother's education was significantly associated with anemia (Adjusted Odds Ratio = 0.46, 95% CI: 0.22 - 0.96, p-value = 0.04). Conclusion The prevalence of anemia among rural adolescent girls who had attained menarche was high. Mother's education status had a protective effect on anemia among adolescent girls.