Cause Of Death In India Research Articles

Impact of shorter MDR tuberculosis regimen drugs on heart rate variability in MDR tuberculosis patients at tertiary care hospital

Background: Tuberculosis is major cause of death in India. Analysis of heart rate variability is one of the most popular methods of autonomic nervous system evaluation. Shorter MDR-TB regimen drugs affect both central nervous system as well as peripheral nervous system. Existing research suggests that active pulmonary tuberculosis causes ANS dysfunction. So, by HRV measurement impact of shorter MDR-TB regimen drugs on autonomic dysfunction can be correlated. Aim of the current investigation was to evaluate effect of shorter MDR-TB regimen drugs on cardiac autonomic regulation in MDR-TB patients with respect to heart rate variability as a parameter.Methods: Fifty newly diagnosed MDR-TB patients of either gender on shorter MDR- TB regimen were enrolled in this study after taking consent. After 20 minutes rest, ECG was taken by “physiopac digital polygraph” software for 5 minutes. Two follow-up HRV assessments were done on 2nd month and 4th or 6th month of treatment. HRV was calculated by root mean square deviation of successive differences between adjacent RR intervals (RMSSD) and low frequency and high frequency ratio.Results: Repeated measures ANOVA showed no statistically significant difference in HRV parameters between baseline, 2 months and 6 months groups. So, sympathetic and parasympathetic modulation in terms of HRV remains unchanged during treatment of MDR-TB with shorter MDR-TB regimen drugs.Conclusions: Shorter MDR-TB regimen drugs don’t have any significant impact on HRV in MDR- TB patients, No correlation was observed between HRV and heart rate in MDR-TB patients.

Quality of Life of Post Stroke Patients and their Caretaker in Chennai

Stroke is one of the leading causes of death in India. Around 2 million Indians suffer from stroke everyyear in India, and the most important cause of severe adult disability. Stroke not only severely affectsan individual’s quality of life, but also their caretaker’s. This burden can result in a deterioration of thecaretaker’s health, social life, and psychological well being such as, emotional health, morale, work life,finances, social mobility, interpersonal relationship and their own family. Here in this study, the quality oflife of 50 stroke patients and their caretaker staying in a tertiary care hospital in Chennai, South India, isassessed using a pretested and validated questionnaire EuroQol EQ-5D-5L which contains questions in 5domains in which each dimensions having five response levels and The EQ-VAS scale which records therespondent’s overall current health on the day of examination on a vertical visual analogue scale from 0-100.The data were entered and coded in Microsoft Excel and analysed based on their frequency, proportion,and severity. About 80% of stroke patients return home after the acute hospitalization and at least onehalf of them require permanent or temporary help from other people in the home setting. Many caregiverssuffer from anxiety/ depression. This study will be useful in analysing the QOL of the patient’s and theircaretaker’s and provide us a new perspective in not only treating the physical aspects of stroke but also itspsychological impact.

Pattern of Injuries Sustained in Cases of Four Wheelers without wearing Seat Belt Infatal Road Traffic Accidents in Mangalore

Introduction: Road traffic accidents (RTAs) have been the bane of the modern civilization accounting for considerableloss to the nation. General callous attitude for safety measures, poor law enforcement and uncontrolled motorizationhave caused significant increase in incidence of RTAs. World Health Organization (WHO) puts RTAs as the sixthleading cause of deaths in India, with a greater share of hospitalizations, deaths, disabilities and socioeconomic lossesin young and middle aged population.Aims and Objective: To study the pattern of injuries sustained in cases of four wheelers without wearing seat beltin fatal road traffic accidents in Mangalore.Materials and Method: All cases of road traffic accidents involving fatal head injuries among four wheelers withoutseat belt which underwent autopsy at the Wenlock District Hospital and Justice K.S Hegde charitable Hospital,Mangalore from January 2009 to December 2013 were included in the study. A proforma was prepared, the detailsabout the pattern of skull fractures and also about intracranial haemorrhages were obtained.Results:Majority of the victims of four wheeler not using seat belt were in the age group of 30-39 Years and 40-49Years (26.83% each). Majority of the victims were male (85.37%).Abrasion (46.34%) was the most common Injuryto face and head followed by laceration (29.27%) was observed.Rib fractures was the most common associatedinjury (43.90%) while no associated injury was observed in 56.10%.Diffuse Extravasation of Blood from Scalp wasobserved in 53.66% while from occipital are was seen in 26.83% victims. Linear Type of fracture in vault was seenin 36.59% of victims. Occipital and frontal bone fracture was observed in 29.27% and 24.39% victims respectively.While studying the Base of skull fractures it was seen that ACF was seen in 24.39% victims while PCF in 19.51%and MCF in 14.63% victims. Most common intra cranial haemorrhage was Sub arachnoid haemorrhage (90.24%)followed by sub dural haemorrhage (82.93%). Brain Oedema was seen in 73.17% victims while Contusion to brainwas seen in 26.83% victims. Frontal lobe of brain was injured in 46.34% victims while diffuse brain injury was seenin 29.27% victims.Conclusion:We conclude that the four wheeler accident among the non seat belt users was common in middle agedmales. Head injury and rib fracture was the most common type of injury observed. Liner fracture of skull withoccipital and frontal bone involvement was common. Most common intra cranial haemorrhage was Sub arachnoidhaemorrhage followed by sub dural haemorrhage. Brain Oedema and Contusion to brain were common brain injury.Frontal lobe brain injuries were common followed by diffuse brain injury.

A Preliminary Trial of the Introduction of Computerized Decision Support to Assist Resuscitation of the Severely Injured in a Level 1 Trauma Centre in India

Injury from motor vehicle accidents remains a leading cause of death in India with increasing number of fatalities. Timely delivery of lifesaving interventions is critical for survival and in restoring physical functioning. As a part of the Australia India Trauma Systems Collaboration, the Trauma Reception and Resuscitation (TRR©)-computerized decision support system was implemented in a Level 1 Trauma Centre in India in order to determine whether this system would reduce the time in performing lifesaving interventions and improve vital sign data capture and documentation. This prospective cohort study at the Jai Prakash Narayan Apex Center, All India Institute of Medical Science, New Delhi, recruited a total of 106 participants into two groups: TRR© (76) and controls (30). During the first 30 min of resuscitation, the TRR© group recorded greater sets of vital signs in compared to the controls for medical records. More importantly, the real-time documentation of the vital signs for the TRR© group ensured accuracy for medical records. For lifesaving interventions, oxygen was administered in the TRR© group only if SpO2 < 93%, whereas oxygen was administered as standard of care in the controls. There was no statistical difference in the mean times to endotracheal intubation, intercostal catheter insertion or performance of emergency chest x-ray between the control and TRR© groups. Importantly however, these 3 comparable interventions were performed consistently within a smaller timeframe for patients receiving care with TRR© decision prompts. There was a greater variability in the time taken to perform lifesaving interventions in the control group in comparison to the clinicians assisted with computerized decision prompts. This preliminary study was not powered to measure difference in mortality and patient recruitment was limited to 8 am–5 pm when trained staff could attend to operating the TRR© system.

Oncology-Based Palliative Care Development: The Approach, Challenges, and Solutions From North-East Region of India, a Model for Low- and Middle-Income Countries.

BACKGROUNDAccess to palliative care within healthcare systems of low- and middle-income countries (LMICs) has never been more pronounced than in current times. The Lancet Commission Report (2018) estimates that 80% of global serious health-related suffering (SHS), which demands access to palliative care for its relief, are in LMICs. Cancer is a major contributor to SHS and a rapidly growing burden in LMICs. Similar to many LMICs, cancer is a leading cause of death in India. The North-East Region (NER) of India has a high prevalence of cancer and paucity of services for cancer and palliative care.OBJECTIVESTo describe the strategies used to initiate and strengthen palliative care services integrated with the comprehensive cancer care initiatives in the state of Assam in NER.METHODSAfter an initial assessment of the status of palliative care in the NER, a multipronged strategy was adopted that aligned with the WHO framework recommended for initiating palliative care services. A core team working with a government and private collaborative strategized and activated supportive policies, education, and training and improved access and availability to essential drugs, while implementing the components synchronously within the state.SIGNIFICANCEThis project demonstrates an informed regional adaptation of the WHO model. It highlights the strengths of integrating palliative care within cancer care program right from its inception. It emphasizes the sustainability of services activated across public healthcare systems, as compared with the donor- or champion-driven initiatives. The outcome of this project underlines the relevance of this model for LMIC regions with similar health systems and sociocultural and economic contexts.

Epidemiological profile, management and outcomes of patients with acute coronary syndrome: Single centre experience from a tertiary care hospital in North India

BackgroundCardiovascular disease is the leading cause of death in India. Our aim is to study the clinical, epidemiological profile and in-hospital outcomes of patients presenting with acute coronary syndrome. MethodsWe did a prospective single center observational study of the 1203 patients presenting with ACS to a tertiary referral center in North India over a period of one year (July 2018–June 2019). ResultsThe mean age of study population was 58.4 ± 12.5 years. STEMI and NSTE-ACS accounted for 69.9% and 31.1% respectively. 62.1% of our patients were from rural background. The median time to hospital admission was 600 min for STEMI patients, thrombolysis was performed in 52% of cases. Cardiogenic shock at presentation was noted in 18%. Coronary angiography and percutaneous coronary intervention were done in 1062 (88.3%) and 733 (60.9%) patients respectively. The overall in-hospital mortality was 7.6%. STEMI patients had higher mortality than NSTE-ACS (8.9% vs 4.5% p < 0.001). Female gender (OR−3.306 C.I. 1.87–5.845), severe MR (OR−4.65, C.I.−1.187–18.18), acute kidney injury (AKI) at admission (OR-5.15, C.I.−2.5–10.63), higher Killip class (class III/IV) (OR−3.378,C.I.−1.292–8.849), AF (OR−3.25, C.I.−1,18–8.92), complete heart block (CHB) (OR−4.44,C.I.−2.09–9.43) and right bundle branch block (RBBB) (OR−2.86, C.I.−1.2–6.8) were significant predictors of in hospital mortality. ConclusionsOur study represents the predominance of STEMI as the initial ACS presentation with a considerable delay in first medical contact and higher prevalence of cardiogenic shock (CS). STEMI patients had higher mortality. Female sex, severe MR, AKI, higher Killips class, AF, CHB, RBBB being predictors of high in-hospital mortality in ACS patients.

Epidemiological profiling of fatal road crashes in Puducherry, South Coastal India.

Road crash fatalities form leading cause of deaths in India. Streamlining road crash data systems are essential for building robust prevention strategies. This study explores epidemiological profile of fatal road crashes in a south Indian urban setting. Between April and June 2019, secondary data on fatal road crashes in Puducherry district for 3-year period (2016, 2017, and 2018) were accessed from traffic police records and analyzed. Raw data accessed in descriptive format was converted to analyzable objective format by self-developed data extraction template. 154 fatal crashes happened in Puducherry during this period. Most victims were males (85.7%), in productive age group (41.5%), with higher rates in monsoon and winter seasons (35.1% each), during evening-to-night hours (41.6%), and during weekends (42%). Most offenders (91.2%) were men, elder than victims, with heavy motor vehicles (91.2%) being the culprit vehicle. Rash driving led to most deaths (53.2%).

Correlation of the severity of obstruction in coronary arteries with serum free testosterone level

Background: Coronary artery disease (CAD) is the leading cause of death in India. There was increased incidence and prevalence of CAD in males than in females. There have been several studies going on across the globe to find a similar equation in males between testosterone and CAD. This study aimed at correlating the serum free testosterone level in CAD patients with the severity of obstruction of the coronary arteries proven by coronary angiogram. This was the first study in South India to correlate the serum free testosterone levels with the severity of obstruction of coronaries. Objective: This study was designed to correlate the serum free testosterone level in male patients above 40 years with proven or newly diagnosed CAD with the severity of obstruction of coronary arteries as evidenced from coronary angiogram. Materials and Methods: This was a hospital-based cross-sectional study conducted from November 2015 to August 2017 in a rural-based teaching tertiary care hospital in Puducherry, India. The sample size was 40, calculated using the formula n = 4 × σ2/d2 from the previous study of serum free testosterone in men with coronary artery atherosclerosis done by Lucyna Sieminska et al. Results: Of 40 patients in the study group, 30% had CAD, 20% had hypertension (HTN), 45% had diabetes mellitus, 45% were smokers, 37.5% were alcoholic, and only 5% had family history of (H/o) CAD. In the study, ejection fraction was

Comprehensive value-based cancer care in India: Opportunities for systems strengthening.

Cancer has been one of the leading causes of death in India in the past decade. The growing cancer burden has generated an unmet need to identify and address gaps in the healthcare system to enable access to affordable and quality cancer care for all in a manner that enhances the value of care. This paper provides an overview of the value-based care approach, identifies areas for enhancing the objectives of value-based care through multi-characteristic and multidimensional consideration of patient centricity and proposes health system strategies to improve comprehensive value-based care in India within the current context, focusing on implications for women’s cancers. The core characteristics of patient centricity – heterogeneity and complexity – are detailed to complement and expand on previously defined aspects of value-based care. Comprehensive value-based cancer care can serve as a test case and proof of concept for the rest of the health system in India and focusing on women’s cancers as a starting point can mandate attention to gender-responsive and transformative design and implementation.

Risk factor profile of stroke patients with special focus on determinants of severity

Stroke is the second major cause of death worldwide and the fourth major cause of death in India. Kerala is becoming the hotspot of lifestyle diseases. Almost 90% of the cases reported in Kerala are associated with one or two modifiable risk factor(s) in the form of lifestyle diseases.Objectives:This study is aimed at risk factor profiling of stroke patients and identifying the determinants of stroke severity. Methods:A descriptive study was conducted among stroke patients admitted in Govt. Medical College Thiruvananthapuram from August to September 2013. The risk factor profile was studied. A case control comparison was done to identify the determinants of severity of stroke. Results:: The age of incidence of stroke ranged from 37 years to 88 years. Mean age was 65.30 (SD =12.80). Hypertension was identified as the most common risk factor followed by diabetes, low physical activity and heart diseases. Limb weakness was the most common clinical presentation. Diabetes Mellitus emerged as an independent risk factor of severity with adjusted odds ratio of 3.82 (1.034-14.09). Conclusion: Hypertension was the most important risk factor prevalent in stroke patients. Diabetes Mellitus was identified as the only independent determinant of severity of stroke. Early identification of risk factors and its proper management should be done with more rigor, in order to decrease the incidence of stroke and reducing its severity.

Feasibility of implementation of simplified management of young infants with possible serious bacterial infection when referral is not feasible in tribal areas of Pune district, Maharashtra, India.

Neonatal infections are a common cause of death in India, but many families cannot access appropriate hospitals for its treatment due to various reasons. We implemented the World Health Organization PSBI management guideline when referral is not feasible within the public health system in Pune, India to evaluate feasibility, barriers and facilitators for its implementation. A national-level consultative meeting between government officials and study partners resulted in a consensus on adaptation and implementation in four demonstration sites in selected states in India. At the state and district levels, similar meetings to plan the implementation strategy and roles were held between KEM Hospital Research Centre (KEMHRC) Pune and the public health system Pune, Maharashtra. The public health system was responsible for implementation of the intervention at eight tribal primary health centres (PHC) in Pune district, India, including delivering the intervention and ensuring supplies of all commodities while KEMHRC was responsible for technical support including training of health workers, assistance in PSBI identification and management, data collection and documentation of the implementation strategy. A total of 175 young infants with PSBI were identified and managed. Of these, 34 had critical illness (CI), 46 had clinical severe infection (CSI) and 10 were infants aged 0-6 days with fast breathing (FB) while 85 infants aged 7-59 days had fast breathing. Assuming a 10% incidence of PSBI among all live births, with 3071 live births recorded, the actual incidence of PSBI found in the study was 5.7%, resulting in an actual coverage was of 57%. Among the 90 infants with CI, CSI and FB in 0-6 days, who were advised referral to government tertiary care centre as per the PSBI guideline algorithm, 81 (90%) accepted referral while 9 (10%) refused and were offered treatment at primary health centres (PHC) with a seven-day course of injectable gentamicin and oral amoxicillin. All infants with FB in 7-59 days were offered treatment at PHCs as per the PSBI guideline algorithm with a seven-day course of oral amoxicillin. All except six infants who died and one with FB in 7-59 days, who was lost to follow-up, were successfully cured. Of the six who died, five had CSI and one had CI. Among the 81 infants with CI, CSI and FB in 0-6 days who accepted referral; 48(53%) were successfully referred to government tertiary facility while 33 (36.6%) preferred to visit a private tertiary health facility. The implementation strategy demonstrated a relatively high fidelity, acceptance and intervention penetration. Lack of training and confidence of the public health staff were major challenges faced, which were resolved to a large extent through supportive supervision and re-trainings. Management of PSBI is feasible to implement in out-patient facilities in the public health system, but technical support to the health system is required to jump-start the process. Fast breathing in 7-59 days old infants can be managed with oral amoxicillin without referral. A sustainable adoption of this intervention by the health system can lead to decrease in neonatal mortality and morbidity.

Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India.

Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India.

To correlate the value of neutrophil to lymphocyte ratio with prognosis of ST-elevation myocardial infarction and non ST-elevation myocardial infarction patients at a tertiary care hospital

Introduction : Myocardial infarction (MI) is one of the leading causes of death in India. Atherosclerosis is the major predisposing factor. Leucocytes play an important role in the formation of arterial thrombus, the healing process and the reperfusion injury in post-MI cases. Hence Neutrophil to Lymphocyte Ratio [NLR] is a potential marker to determine inflammation in cardiac disorders. It is inexpensive, easy to obtain and is widely available. Material and Methods: A detailed medical history was obtained from the study population. Report of ECG changes, absolute neutrophil count and absolute lymphocyte count at the time of admission was noted down from the laboratory reports attached to the case sheets. The NLR was calculated. The patients were classified into 2 groups based on ECG changes 1. STEMI group 2. NSTEMI group Follow up was done for the duration of hospitalisation and complications, if any during this period were noted. Discussion: The study included a total of 62 study subjects with 31 in STEMI group and 31in NSTEMI group. Among MI cases with NLR < 2> Among MI cases with NLR 2.5, 13/47 cases were referred to higher centre and 34/47 were discharged. In this study, NLR between 2 groups had no statistically significant difference in occurrence of complications Conclusion: This study demonstrated that average NLR is not useful indicator of adverse-outcomes during hospitalization in patients presenting with STEMI and NSTEMI. Keywords: Myocardial infarction, STEMI, NSTEMI, Neutrophil to Lymphocyte ratio.

THE EFFECT OF GENERAL LIFE STYLE BEHAVIOUR ON LIPID PROFILE OF BLOOD DONORS: TO IMPROVE QUALITY OF BLOOD SUPPLY IN BLOOD BANKS

Aim: Hyperlipidemia are thought to be a risk factors for cardiovascular disease (CVD) which are a major cause of death in India and worldwide which could be affected by lifestyle behavior including physical activity, sedentary life style and weight. Hyperlipidemia could hampers blood supply and blood products so donor selection and screening could be done for hyperlipidemia as donor selection and screening is important steps for the safety of blood transfusion procedure. The aim of the present study was to investigate the association of hyperlipidemia with donor criteria with their life style parameters. Subject and Methods: The present research was a cross-sectional study based on voluntary blood donation from Dec 2016-Dec2017. 300 fasted samples of blood donors were collected from Department of Transfusion Medicine King George’s Medical University Lucknow. Lipid profile analysis was performed at Department of Biochemistry King George’s Medical University, Lucknow. Results: Results summarized as significant association (p

P1616ASSESSMENT OF SEQUENTIAL CHANGES OCCURRING IN THE BODY FLUID COMPOSITION BY BIO-IMPEDANCE ANALYSER IN PRE AND EARLY POST RENAL TRANSPLANT PATIENTS

Abstract Background and Aims Chronic kidney disease is now recognized as major causes of death in India. The Global Burden of Disease (GBD) study 2015, ranked chronic kidney disease as 17th among the causes of deaths globally (age standardized annual death rate of 19·2 deaths per 100 000 population). Deaths due to renal failure constituted 2·9% of all deaths in 2010–13 among 15–69 year-olds, an increase of 50% from 2001–03. These are varies metabolic derangements in CKD patients, among which volume overload is the major problem contributing uncontrolled hypertension and increases cardiovascular mortality. There will be increased total body water (TBW) and extracellular water (ECW) at the expense of reduced intracellular water (ICW). Renal replacement therapies such as dialysis or kidney transplantation are the major treatment modalities. Renal transplantation is the treatment of choice for end stage renal failure patients. Despite improving renal dysfunction, patients are at risk for existing or new onset of conditions after transplantation and may alter the body fluid physiology. Till date, renal transplant patients received little attention towards fluid balance and nutritional status. There are many studies supporting the use of bioimpedance analyzer as a reliable tool in assessing the fluid status in haemodialysis patients, but there are very few studies done in post renal transplant patients to know their fluid status with single functioning kidney where Glomerular filtration rate are generally much lower than normal. Method fifty renal transplant recipients were followed in our centre for 6 months (68 males, maximum were in 31-45years of age). Biochemical parameters like haemoglobin, urea, creatinine, electrolytes, albumin, estimated glomerular filtration rate (eGFR); TBW, ECW, ICW and over hydration (OH) measured using bioimpedance analysis (BCM, Fresenius) were evaluated at baseline (pre-transplant) and after transplant at 3 and 6 months. Baseline biochemical and bio-impedance values were compared with 3 and 6 months post transplant. Patients were divided into 3 sub-groups based on eGFR: good graft function (eGFR &amp;gt;60 ml/min), borderline graft function (eGFR 30-60 ml/min) and severe graft dysfunction (eGFR &amp;gt;30 ml/min/1.73m2). TBW, ECW, OH and ICW were compared between the sub groups of eGFR at 3 and 6 months post transplant. Results Comparing before transplant with 3 and 6 months post-transplant, TBW, ECW and OH were reduced while ICW increased significantly with good graft function. On comparing 3 months to 6 months post-transplant, ECW, TBW, OH reduced further but there was not much difference in ICW. OH at 6 months post-transplant was 0.6 L (within normal range of gender-matched individuals from the reference population, that is, −1.1 to 1.1 L). In patients with severe graft dysfunction (&amp;lt;30ml/min), TBW, ECW and OH were remained high when compared to borderline (31-60ml/min) and with good graft function group (&amp;gt;60ml/min). Biochemical improvement was comparable with bio-impedance parameters at 3 months and 6 months post transplant with good graft function. Conclusion The BIA showed significant reduction in TBW, ECW and OH by 6 months post transplant and ICW increased as graft function improved post transplantation by 3 months and thereafter, change was not significant. Parameters of Bio-impedance analyzer of well-functioning kidney transplant recipients showed that the altered body water compartments quickly normalizes which is never achieved by a hemodialysis session. We found that Bio-impedance analyzer was useful to know the changes in body fluid composition in post renal transplant patients.

Drug utilization study in intensive cardiac care unit of tertiary care hospital

Introduction: Patients admitted in Intensive Cardiac Care unit (ICCU) are critically ill cardiac patients. Cardiovascular diseases (CVDs) are the main cause of mortality globally and are the leading cause of death in India also. The Intensive Cardiac Care unit is routinely equipped with a system that permits continuous monitoring of the cardiac rhythm of each patient and hemodynamic monitoring in selected patients. The various drugs used in ICCU and there clinical outcome was investigated in this study. Materials and Methods: Patients admitted between January 2017 – June 2018 in Medicine Intensive cardiac care unit were included in this study. Results: Total of 359 prescriptions was analyzed from the Intensive cardiac care unit. Out of 359 patients, 228 (63.51%) were male, while 131 (36.49%) were female. The mean age of the patients admitted in ICCU was 55.68 +13.54 years. The most common type of patients admitted in ICCU have the diagnosis of Acute myocardial infarction (77.16%), followed by Ischemic heart disease (8.36%), Cardiogenic shock (4.18%), Left Bundle Branch Block (3.62%), Rheumatic heart disease (2.79%) and Supraventricular tachycardia (2.23%). The most common drugs prescribed in ICCU were Aspirin, Clopidegrol and Atorvastatin. Other drugs most commonly used are Metoprolol (95.82%), Ramipril (92.48%), Isosorbitedinitrate (86.07%), Ranitidine (83.29%). Conclusion: In conclusion, after analyzing the prescriptions we found that the drugs used in ICCU like anti-platelets (clopidogrel and aspirin), anti-coagulants (LMWH), statins (atorvastatin) and nitrates (Isosorbidedinitrate) were in large quantities. This finding correlates with the standard recommended guidelines for cardiovascular emergencies. The present study provides valuable insight about the overall pattern of drugs used in intensive cardiac care unit. Keywords: Drug utilization study, Intensive cardiac care unit, Anti-platelets.

Abstract P465: Standardizing Hypertension Management In A Primary Care Setting In India Through A Protocol Based Model

Hypertension is a leading cause of death in India. There are numerous barriers to adequate management of hypertension in Indian healthcare settings, including therapeutic inertia and the lack of a systematic approach. Standardizing hypertension management through an evidence based model that sets thresholds for diagnosis, treatment goals, follow up intervals and choice of drugs can lead to improved management of hypertension in an individual hospital or health system. We describe the design of a model that focuses on efficacy, safety and ease of use by healthcare providers with different levels of training. The algorithm endorses a urine albumin first approach in deciding the course of antihypertensive therapy. Providers undergo training in the implementation of this model using a training guide and handout developed for this purpose. The algorithm itself can be utilized as a point of care reference by individual practitioners, hospitals, primary health centers (PHCs) and the Health and Wellness Centers (HWCs) under the Ayushman Bharat initiative. We plan to evaluate the effectiveness of our model at Shree Krishna Hospital, Gujarat, India through a quality improvement framework. The algorithm is designed to allow adaptability to individual institutional requirements in India (and similar low and middle income countries) while standardizing the basic elements of hypertension management.

A study to detect preinvasive and invasive cancer

Introduction and objectives: Cervical cancer is the 2nd leading cause of female cancer death in India. The Papanicolau (PAP) smear is the most successful screening test for carcinoma, since its introduction the national death from cervical cancer has dropped by 70%. In rural India, pregnancy may be the only reason for women to undergo PAP smear examination to rule out any associated cervical lesions. Hence, our study based on cervical cancer screening will help in achieving the objectives of National Cancer Screening Programme. Materials and Methods: 137 antenatal cases were taken from the department of Obstetrics and Gynaecology of our institute. It was a cross-sectional study with 18 months duration. Results: Among 137patient studies, mean age under the study was 24.17years, most of them were in their third trimester.16.05% cases were younger than 20 years of age and large proportion of 32.11% was between 21-23 years of age. Most of the subjects (75.9%) were married above 18 years and 48.2% were primipara, 56.2% belongs to low socioeconomic status, 45.3% were uneducated and only 32.1% were aware of pap smear. None of the pap smears reported any intraepithelial lesion. Interpretation and Conclusion: Women having cervical lesions during initial screening were asked to revisit for further detailed evaluation. In cases of high grade dysplasia or in the presence of cervical cancer treatment should be initiated at the earliest. Hence, our study based on cervical screening programme using PAP smears will help to sensitize and create awareness among the rural population regarding prevention of carcinoma of cervix and thereby contribute towards the National Cervical Screening Programme. Keywords: Pap, CIN, Carcinoma cervix.

Epidemiological profile and management patterns of acute myocardial infarction in very young patients from a tertiary care center

BackgroundCardiovascular disease is the leading cause of death in India. Previously it was thought to be a disease of the elderly but now an epidemiological transition is being seen with increasing incidence in the very young adults as well. Such patterns are not well studied in the South East Asian population. ObjectiveTo study the epidemiological profile of very young (≤35 years) adults presenting with an acute myocardial infarction (AMI) in comparison with an older cohort. MethodologyThe present study included all patients presenting with AMI to the emergency or to the out-patient department of the G B Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi between January 2014 and October 2015. A total of 102 subjects ≤35 years with AMI comprised the study subjects (cases) and were compared with 104 subjects >35 years old with AMI (Controls). Results & conclusionMost of the very young AMI patients presented with an anterior wall ST segment elevation myocardial infarction, a stable hemodynamic profile, single vessel disease and better left ventricular ejection fraction as compared with controls. Most of the patients were from urban and semi-urban areas, middle and lower middle socioeconomic status and were smokers but lacked other traditional risk factors.

Detection of Lung Diseases using Deep Learning

There is an increasing risk on health due to changing environment, climate and lifestyle. India tops the world in deaths due to lung diseases. They were the second highest cause of deaths in India after heart disease in 2017, killing 1 million (958,000) Indians that year. Early diagnosis and treatment of lung diseases is critical to prevent complications including death. Chest X-ray is currently the best available method for diagnosis, playing a crucial role in clinical care. Using Deep Learning to predict lung diseases from Chest Xrays can be a lifesaving factor for an individual suffering from the disease. This is possible as the results can be predicted with a high percentage of accuracy instantly. This paper presents an effective way for expert diagnosis of lung diseases using Deep Learning. It focuses on creating a system for assistance of Radiologists in detection of lung diseases. This will especially benefit rural areas where radiologists aren’t easily available. Our system connects radiology labs with the radiologists who can diagnose faster and better with our model.