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   Table of Contents - Current issue
January-March 2020
Volume 9 | Issue 1
Page Nos. 1-36

Online since Monday, March 16, 2020

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Editor's Page January 2020 p. 1
Ravi R Kasliwal
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Total cardiovascular risk assessment of women in delta state, Nigeria, using the world health Organization/International Society of Hypertension risk prediction chart p. 2
Ejiroghene Martha Umuerri, Irikefe Paul Obiebi
Background: Globally, women are not exempt from the menace of cardiovascular diseases. Methods: This cross-sectional study assessed the 10-year cardiovascular risk (CVR) for stroke or myocardial infarction of women aged ≥18 years attending opportunistic medical screening programs in two suburban communities in Delta State, Nigeria. Consenting women were consecutively recruited for the study, and the study instrument was the World Health Organization/International Society of Hypertension prediction chart for Africa (AFR D) without blood cholesterol. Total CVR was graded as low (<10), moderate (10–<20), and high (≥20). Results: Data from 456 women were analyzed; 50.9% were aged >40 years, 9.9% had never married, and 39.9% had a secondary level of education. The mean body mass index (29 vs. 27 kg/m2), systolic blood pressure (140 vs. 121 mmHg), diastolic blood pressure (87 vs. 77 mmHg), and blood glucose (104 vs. 92 mg/dl) were significantly higher among women aged ≥40 years. Smoking, hyperglycemia, and hypertension were noted in 0.0%, 7.0%, and 34.4% of the women, respectively. The 10-year risk of stroke or myocardial infarction was low in 87.7%, moderate in 7.2%, and high in 5.0% of the women. All the respondents with high CVR were aged ≥40 years. Among respondents aged <40 years, 98.2% had low CVR. Significant associations were observed between CVR and age (P < 0.001), marital status (P = 0.047), and level of education (P < 0.001). Conclusion: This study shows that 12.2% of the women have a moderate-to-high 10-year risk of stroke or myocardial infarction. Increasing age and lower educational levels were significantly associated with a high CVR. Educating women indeed have far-reaching benefits on their cardiovascular health.
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Baseline High-Sensitive-Cardiac Troponin I as a Predictor of Fatality in Stable Chronic Heart Failure Patients in Nigeria p. 8
Olusegun O Areo, Samuel A Atiba, Paul Olowoyo, Olusegun A Busari
Background: The prognostic value of high-sensitive-cardiac troponin I (hs-cTnI), a biomarker for heart failure (HF), has been well studied in developed countries. However, its significance in patients with chronic HF (CHF) in Nigeria and Africa at large remains unknown. Methods: This was a hospital-based prospective study. Sixty-four consecutive consenting patients with clinical and echocardiographic evaluation for HF attending cardiology clinic were recruited. They all had resting 12-lead electrocardiogram done. Blood sample for serum hs-cTnI assay (enzyme-linked immunosorbent assay), electrolytes, urea, and creatinine was obtained at recruitment and at 6 months. The participants were followed up monthly for 6 months from baseline to determine the case fatality rate and hospitalization rate. Results: At the end of 6 months, four patients were lost to follow-up. Eight participants died of HF-related cause and had statistically significantly higher mean recruitment serum hs-cTnI levels than the survivors (0.35 ± 0.05 ng/ml vs. 0.23 ± 0.02 ng/ml),P ≤ 0.001. Baseline hs-cTnI ≥0.25 ng/ml was found to be an independent significant prognostic predictor of HF fatality on Cox regression analysis. Conclusions: This study demonstrated that hs-cTnI was predictive of HF fatality in a cohort of patients with CHF in Nigeria. Thus, it may be used to risk stratify patients as a guide to identify those likely to benefit from more aggressive management.
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Are the urban slum population physically inactive? A descriptive study from urban Puducherry p. 13
Bijaya Nanda Naik, Kalaiselvi Selvaraj, Praveena Daya, Sitanshu Sekhar Kar
Context: Physical inactivity is an important modifiable behavioral risk factor for noncommunicable diseases (NCDs). However, adequate attention has not been paid to it, especially in low- and middle-income countries like India as like other risk factors due to challenges in the administration of tools to measure physical activity. Aims: This study was conducted to assess the level of physical inactivity and contributing factors in an urban slum of Puducherry. Settings and Design: Urban community, cross-sectional study design. Materials and Methods: After obtaining consent, relevant information on sociodemographic details and physical inactivity was collected, during the house-to-house survey, using a pretested semistructured questionnaire from each household of the study areas. A total of 3300 adults (aged 30 years or above) were included in the study. Physical inactivity was defined as <150 min of leisure time moderate exercise in a week. Statistics: The results were summarized as means and proportions. Results: Nearly three-fourth of the participants were physically inactive. About 79% of the females against 70% of the males were found to be physically inactive. Physical inactivity was found to be decreasing with increase in age: 30–44 years age (77.2%), 45–59 years age (75.3%), and 60 years and above (72.2%). Individuals with chronic diseases and obesity were found to be less physically inactive. Gender, age, education, socioeconomic status, occupation, alcohol use, and obesity were found to be associated with physical inactivity. Conclusion: Physical inactivity was very high in the study population, especially among young adults and females. Health education intervention targeting these populations can decrease the level of physical inactivity and in the long-run burden of NCDs in the study population.
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Prevalence and major cardiac causes of cardio-embolic stroke and in-hospital mortality in Eastern Nepal p. 19
Rajesh Nepal, Manoj Kumar Choudhary, Sahadev Dhungana, Sushant Katwal, Sunil Babu Khanal, Madhav Bista, Abdul Khaliq Monib, Dilli Ram Kafle
Background: Cardioembolism accounts for 15%–30% of all ischemic strokes. The study aims to assess conventional and major cardiac causes of cardio-embolic stroke, its prevalence, lesions associated with the side of weakness, and in-hospital mortality. Materials and Methods: Patients with cardio-embolic stroke over 18 months were included in the study. Groups were compared using Chi-square test and Student's t-test. Results: In 384 patients with ischemic stroke, 168 (44%) had a cardio-embolic stroke. Among these 168 cardio-embolic patients, 56% were male and 44% female with a mean age of 69 ± 1 year. Dyslipidemia (72%), hypertension (69%), smoking (34%), and diabetes (33%) were the most prevalent conventional cardiovascular risk factors in these patients. Atrial fibrillation (AF) (71%) was the most common specific cardiac cause for cardio-embolic stroke. Hypertension was present in more than 76%, while dyslipidemia in 66% of patients with AF. Seventeen patients (10%) had in-hospital mortality, while nine (5%) left the hospital against medical advice. The in-hospital mortality rates were not different in AF patients as compared to those with sinus rhythm (59% vs. 41%,P = 0.225). However, patients with left ventricular ejection fraction ≤50% had a higher rate of mortality when compared to patients with normal ejection fraction (P < 0.001). Patients with AF had a higher incidence of left-sided weakness when compared to sinus rhythm (P = 0.049). Conclusion: Hypertension and dyslipidemia were the most prevalent conventional risk factors, while AF was the most common cardiac cause of cardio-embolic stroke. Reduced left ventricular ejection fraction less than 50% was significant predictor of in-hospital mortality in cardio-embolic stroke patients.
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Comparison of prothrombin time and international normalized ratio values using point-of-care system with a standardized laboratory method in patients on long-term oral anticoagulation – A prospective study p. 25
Raghuram Palaparti, Gopala Krishna Koduru, Sudarshan Palaparthi, PS S Chowdary, Purnachandra Rao Kondru, Somasekhar Ghanta, Mannuva Boochi Babu, Prasad Maganti, Sasidhar Yendapalli, KV N Srikanth, Rohini Medasani
Background: In our country, methods of prothrombin time (PT) and international normalized ratio (INR) testing have not been standardized across various centers. Often, we find disparity in INR values from different laboratories, posing a challenge to make an appropriate clinical decision. Objective: The objective of the study was to compare and correlate the PT/INR values using a point-of-care (POC) system with standardized laboratory (SL) testing and to evaluate the efficiency of the POC system in monitoring patients. Methods: We have prospectively compared PT/INR values between a commercially available POC, CoaguChek XS System, Roche, and SL testing in 205 patients and 353 samples from July 2017 to April 2018. Results: The overall strong correlation between POC PT/INR values and simultaneous standard laboratory values was noted. The overall coefficient of correlation among the two groups was 0.919 (P = 0.001) for INR values. In INR range of 2–3.5, the values correlated well with a coefficient of correlation, 0.756 (P = 0.001). In INR range <2, the values correlated with a coefficient of 0.98. The correlation was poor when the INR values were >4. Conclusions: In this comparison study, statistical analysis yielded a good correlation between POC PT/INR values and SL values in therapeutic and subtherapeutic range. POC testing is a good alternative to SL testing. If widely available, POC testing may enable patient self-testing and self-monitoring. In our experience, POC testing had added benefits in emergency settings. However, clinicians and laboratory professionals should be aware of the occasional disagreement between POC INR and standard laboratory INR values.
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Percutaneous intervention in thrombotically occluded grafted renal artery p. 31
Vilas Magarkar, Devendra Borgaonkar, Pravir Lathi, Suhas Bavikar
Early kidney loss due to thrombosis of the renal artery is a rare yet a dreaded vascular complication. Arterial thrombosis can be averted only if arterial inflow is regarded as the cause of poor graft function and intervention is undertaken immediately. We report our experience of percutaneous intervention in a case of renal arterial thrombosis following renal allograft transplant.
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Recent trials in heart failure p. 34
Mayank Gupta, Rahul Mehrotra
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