Study of Correlation of Serum Vitamin D Levels with Arterial Stiffness and Cardiovascular Morbidity in Elderly Individuals of Western Rajasthan.

Introduction: Vitamin D deficiency is highly prevalent condition in western countries as well as in India. Lower level of vitamin D is associated with increased arterial stiffness by activating renin-angiotensin-aldosterone system leading to increased cardiovascular morbidity and mortality including increased risk of coronary artery disease, stroke, peripheral vascular disease, hypertension, diabetes mellitus and metabolic syndrome. Our aim was to study the correlation between serum vitamin D level, various measures of arterial stiffness and cardiovascular morbidity in elderly individuals. Material and Method: The present study was conducted in collaboration with Department of Medicine, Department of Cardiology and Regional Geriatric Centre, NPHCE, MDM Hospital attached to Dr. S.N. medical college Jodhpur. Total 100 elderly individuals 60 yrs and above attending hospital for minor short illness, acute illness or for routine health checkup or with acute coronary events are included in the study. Vitamin D level was assessed by chemiluminescent immunoassay. Pulse Wave Velocity was determined by Periscope. Results: In subjects with coronary artery disease, 28.30% were vitamin D deficient, 49.05% were vitamin D insufficient and only 22.64% are vitamin D sufficient. In healthy subjects, 25.53% were vitamin D deficient, 23.40% were vitamin D insufficient and 51.04% were vitamin D sufficient. The difference between these groups was statistically highly significant. (p value-0.006). Various measures of arterial stiffness including Rt baPWV, Lt baPWV, cf PWV and pulse pressure are more in vitamin D deficient group as compared to vitamin D sufficient group. The difference was statistically significant. Conclusion: Vitamin D deficiency is quite common condition in elderly individuals which besides its bone mineralization action is also involved in cardiovascular functions. Deficiency of vitamin D may cause increase in arterial stiffness and widening of pulse pressure which are the predictor of atherosclerosis and cardiovascular morbidity and mortality.

Efficacy of Low-Dose Chlorthalidone and Hydrochlorothiazide as Assessed by 24-h Ambulatory Blood Pressure Monitoring.

BACKGROUND: Thiazide and thiazide-like diuretic agents are being increasingly used at lower doses. Hydrochlorothiazide (HCTZ) in the 12.5-mg dose remains the most commonly prescribed antihypertensive agent in the United States. OBJECTIVES: This study compared chlorthalidone, 6.25 mg daily, with HCTZ, 12.5 mg daily, by 24-h ambulatory blood pressure (ABP) monitoring and evaluated efficacy. Because HCTZ has been perceived as a short-acting drug, a third comparison with an extended-release formulation (HCTZ-controlled release [CR]) was added. METHODS: This 12-week comparative, double-blind, outpatient study randomized 54 patients with stage 1 hypertension to receive either chlorthalidone, 6.25 mg, (n = 16); HCTZ 12.5 mg (n = 18); or HCTZ-CR 12.5 mg (n = 20). ABP monitoring was performed at baseline and after 4 and 12 weeks of therapy. RESULTS: All 3 treatments significantly (p < 0.01) lowered office BP at weeks 4 and 12 from baseline. At weeks 4 and 12, significant reductions in systolic and diastolic 24-h ambulatory and nighttime BP (p < 0.01) were observed with chlorthalidone but not with HCTZ. At weeks 4 (p = 0.015) and 12 (p = 0.020), nighttime systolic ABP was significantly lower in the chlorthalidone group than in the the HCTZ group. With HCTZ therapy, sustained hypertension was converted into masked hypertension. In contrast to the HCTZ group, the HCTZ-CR group also showed a significant (p < 0.01) reduction in 24-h ABP. All 3 treatments were generally safe and well tolerated. CONCLUSIONS: Treatment with low-dose chlorthalidone, 6.25 mg daily, significantly reduced mean 24-h ABP as well as daytime and nighttime BP. Due to its short duration of action, no significant 24-h ABP reduction was seen with HCTZ, 12.5 mg daily, which merely converted sustained hypertension into masked hypertension. Thus, low-dose chlorthalidone, 6.25 mg, could be used as monotherapy for treatment of essential hypertension, whereas low-dose HCTZ monotherapy is not an appropriate antihypertensive drug. (Comparative Evaluation of Safety and Efficacy of Hydrochlorothiazide CR with Hydrochlorothiazide and Chlorthalidone in Patients With Stage I Essential Hypertension; CTRI/2013/07/003793).

Shapiro syndrome.

We report here a case of Shapiro syndrome who presented with episodic generalized sweating, hypotension, and hypothermia. Brain magnetic resonance imaging demonstrated corpus callosum agenesis with colpocephaly. Patient was treated with Clonidine and Propranolol. This case is being reported here because only a few cases of Shapiro Syndrome are reported in world literature.

Clinical profile and mortality among novel influenza A (H1N1) infected patients: 2009-2010 Jodhpur, Rajasthan pandemic.

OBJECTIVES: Influenza causes annual seasonal epidemics around the world. Periodically, a genetically novel strain of influenza circulates worldwide, causing an influenza pandemic. The present study aims to assess the clinical profile, factors determining the response, prognosis of the disease and outcome in H1N1 positive patients during 2009-2010 H1N1 pandemic, so that epidemiology of the disease could be known and high risk groups can be identified. METHODS: Medical records of the H1N1 positive patients, confirmed by RT-PCR method, admitted in ICU/Isolation ward in M.D.M. Hospital, Jodhpur during pandemic of H1N1 influenza (2009-2010) were retrieved and retrospectively studied, the data collected was analysed. RESULTS: During the study period there were 221 H1N1 positive admissions. The age group most affected was 21-40 years in both males (52%) and females (67%). There were 80 deaths; mortality was high in rural population (64%) and pregnant women particularly in third trimester (80%). Common presenting symptoms were Cough, Fever, Breathlessness, Sore throat, Nasal Discharge, Expectoration and Body aches, other less common symptoms were Headache, Vomiting, Diarrhoea and Fatigue. CONCLUSION: Swine flu influenza infection took its heaviest toll in terms of human lives and economy because the young and productive population was mostly affected. Pregnant women and the patients with co-morbid conditions were the susceptible population and thus preventive and therapeutic interventions should be directed to them. Early vaccination of high risk groups and high index of suspicion in the symptomatic patients and chemoprophylaxis accordingly can save many human lives.

Case report of a small outbreak of epidemic dropsy.

Epidemic dropsy results from use of edible oils adulterated with Argemone mexicans oil. We report of the disease in a family caused due to sesame oil adulteration. Peculiarity to report this disease is that it occurred due to consumption of contaminated sesame seeds oil instead of mustard oiland secondly epidemic dropsy is also not very common in western Rajasthan. Five members of a family presented to the hospital with history of generalised body swelling, itching and marked cutaneous flush. Few of them also have shortness of breath, dry cough, palpitation, diarrhoea, vomiting and haemoptysis. On physical examination rashes, pallor and signs of cardiac failure were present in few patients. None of them had neurological symptoms and signs. After multiple interviews history of consumption of home made sesame seeds oil was explored in the family and the differential diagnosis of epidemic dropsy was made. Edible oil sample of the sesame seeds oil turned out to be positive for sanguinarine. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil, which cause widespread capillary dilatation, proliferation and increased capillary permeability. Leakage of the protein-rich plasma component into the extracellular compartment leads to the formation of oedema. There is no specific therapy. Removal of the adulterated oil and symptomatic treatment of congestive cardiac failure and respiratory symptoms, along with administration of anti-oxidants and multivitamins, remains the mainstay of treatment.

Effect of tobacco use on arterial stiffness in community dwelling females.

AIMS: The goal of this study was to investigate the changes in arterial stiffness by evaluation of arterial stiffness index and pulse wave velocity in community dwelling tobacco user females and to correlate those changes with duration of tobacco use, amount consumed and severity of addiction. METHODS: This observational cohort study was conducted in Department of Medicine at Dr. S N Medical College, Jodhpur, comprised of 100 females, out of which 55 were community dwelling females using tobacco (cases) and 45 are age-sex matched healthy control group. Out of 55 tobacco user females 21 (38%) were smoker and 34 [62%] were smokeless tobacco user. Pulse wave velocity and arterial stiffness index were evaluated by means of an 8-channel real-time PC-based simultaneous acquisition and analysis system (Periscope). RESULTS: Average C-F PWV in tobacco user female was 1327 +/- 515.2 as compared to 796 +/- 157.3 in control and average ASI was 71 +/- 20.9 in tobacco user female as compared to 62 +/- 13.9 in control that is statistically significant (p < or = .05). Both C-F PWV and ASI were significantly higher in tobacco user than control. Average C-F PWV in smoker group is 1683 +/- 566.7 as compared to 1108 +/-387.9 in smokeless group. Average ASI is 76 +/- 22.9 in smoker group as compared to 66 +/- 18.9 in smokeless tobacco user group. Both C-F PWV and ASI were higher in smoker group than smokeless group that is statistically significant (P Value 0.0018). CONCLUSIONS: This study has demonstrated that PWV and ASI are increased in tobacco user females and they are independent predictor of cardiovascular morbidity. Tobacco use either smoking or smokeless causes Atherovascular diseases. Smoking is more prone to increase atherosclerosis and cardiovascular morbidity in comparison to smokeless tobacco use.