mmHg Research Articles

Hypertension, antihypertensive drugs, and age at onset of Huntington’s disease

BackgroundAssociations between blood pressure (BP) with age at onset of Huntington’s disease (HD) have reported inconsistent findings. We used Mendelian randomization (MR) to assess effects of BP and lowering systolic BP (SBP) via the genes encoding targets of antihypertensive drugs on age at onset of HD.MethodsGenetic variants from genome-wide association studies(GWAS) of BP traits and BP-lowering variants in genes encoding antihypertensive drugs targets were extracted. Summary statistics for age at onset of HD were retrieved from the GWAS meta-analysis of HD residual age at onset from the GEM-HD Consortium included 9064 HD patients of European ancestry (4417 males and 4,647 females). MR estimates were calculated using the inverse variance weighted method, supplemented by MR-Egger, weighted median, and MR-PRESSO methods.ResultsGenetically predicted SBP or diastolic BP increase was associated with a later age at onset of HD. However, after SBP/DBP was present as a covariate using multivariable MR method, no significant causal association was suggested. A 10-mm Hg reduction in SBP through variants in genes encoding targets of calcium channel blockers (CCB) was associated with an earlier age at onset of HD (β=-0.220 years, 95% CI =-0.337 to -0.102, P = 2.42 × 10− 4). We did not find a causal association between angiotensin converting enzyme inhibitors and β-blockers with the earlier HD onset. No heterogeneity and horizontal pleiotropy were identified.ConclusionsThis MR analysis provided evidence that genetically determined SBP lowering through antihypertensive drugs might be associated with an earlier age at onset of HD. The results may have a potential impact on management of hypertension in the pre-motor-manifest HD population.

End-tidal Carbon Dioxide + Return of Spontaneous Circulation After Cardiac Arrest (RACA) Score to Predict Outcomes After Out-of-hospital Cardiac Arrest.

The return of spontaneous circulation after cardiac arrest (RACA) score is a well-validated model for estimating the probability of return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) by incorporating several variables, including gender, age, arrest aetiology, witness status, arrest location, initial cardiac rhythms, bystander cardiopulmonary resuscitation (CPR), and emergency medical services (EMS) arrival time. The RACA score was initially designed for comparisons between different EMS systems by standardising ROSC rates. End-tidal carbon dioxide (EtCO2) is a quality indicator of CPR. We aimed to improve the performance of the RACA score by adding minimum EtCO2 measured during CPR to develop the EtCO2 + RACA score for OHCA patients transported to an emergency department (ED). This was a retrospective analysis using prospectively collected data for OHCA patients resuscitated at an ED during 2015-2020. Adult patients with advanced airways inserted and available EtCO2 measurements were included. We used the EtCO2 values recorded in the ED for analysis. The primary outcome was ROSC. In the derivation cohort, we used multivariable logistic regression to develop the model. In the temporally split validation cohort, we assessed the discriminative performance of the EtCO2 + RACA score by the area under the receiver operating characteristic curve (AUC) and compared it with the RACA score using the DeLong test. There were 530 and 228 patients in the derivation and validation cohorts, respectively. The median measurements of EtCO2 were 8.0 times (interquartile range [IQR] 3.0-12.0 times), with the median minimum EtCO2 of 15.5 millimeters of mercury (mm Hg) (IQR 8.0-26.0 mm Hg). The median RACA score was 36.4% (IQR 28.9-48.0%), and a total of 393 patients (51.8%) achieved ROSC. The EtCO2 + RACA score was validated with good discriminative performance (AUC, 0.82, 95% CI 0.77-0.88), outperforming the RACA score (AUC, 0.71, 95% CI 0.65-0.78) (DeLong test: P < 0.001). The EtCO2 + RACA score may facilitate the decision-making process regarding allocations of medical resources in EDs for OHCA resuscitation.

Differentiating Shock Associated with Multi-inflammatory Syndrome in COVID-19 and Dengue – A Case Report

In India where dengue is endemic, differentiating dengue shock and shock due to multi-inflammatory syndrome in COVID become important. Only a few case reports of such cases are present in the literature and we describe a child who was being managed as dengue developed shock and fitted in definition of multisystem inflammatory syndrome in children (MIS-C). She had positive for dengue NS1 and had raised COVID-19 antibodies. Her capillary refill time was prolonged and her blood pressure was 72/37 mm of Hg. In view of shock, she was given fluid bolus and started on adrenaline infusion. She was given intravenous immunoglobulin and methyl prednisolone. With this management, she improved. When we consider type of shock in dengue, it is narrow pulse pressure, while in our child, this was wide pulse pressure. Hence, we decided to treat with inotropes after initial fluid bolus of 20 mL/kg. We conclude that while differentiating dengue shock from MIS-C shock, pulse pressure may be important adjunct.

Low-Pressure Laparoscopic Surgery is a Viable and Risk-Free Alternative to Standard Pressure for the Treatment of Benign Gall Stone

When compared to the open cholecystectomy, laparoscopic cholecystectomy (LC) has the benefits of less post-operative pain and quicker return to work. However, up to 80% of individuals after laparoscopic surgery still experience significant pain and needing pain relief. Methodology: The reason for this research was to compare the results of LC performed with and without LPP. LC requires the surgeon to choose a pneumoperitoneum pressure that maximizes working space while avoiding unintended side effects. This study used a Randomized Controlled Trial (RCT) design, and it was done at the West Surgical Ward at Mayo Hospital in Lahore. The study enrolled 60 participants who met the inclusion criteria. The patients were split in two groups: Low-pressure pneumoperitoneum-LPP (Group A) (06-10 mm of Hg) and pneumoperitoneum at standard pressure (SPP) is part of Group B. (12-16 mm of Hg). All had opted for a LC to treat their symptomatic gallstone disease. At 4, 8, and 24 hours following surgery, the severity of postoperative shoulder pain (if present) was evaluated using a visual analogue pain scale (VAS). The frequency of postoperative nausea and vomiting was assessed at 4, 8, 12, and 24 hours. Results: The patients were 35.63 years old on average. Majority of these two groups has no complications. Based on the data, we discovered that the frequency of episodes of nausea/vomiting in both groups was very low and that only a few patients had bouts of nausea/vomiting in the 4 hours and 24 hour time intervals. Conclusion: We have come to the conclusion that LP laparoscopic surgery is a viable and risk-free alternative to SP laparoscopic operation for the treatment of benign gall stone disorders. Our findings lead us to the conclusion that LPP is a superior option for the LC since it reduces the post-operative pain in the shoulder and the risk of PONV while not significantly increasing the risk of intraoperative complications. Keywords: Benign Gall Stone, Treatment, Low-Pressure Laparoscopic Surgery,

NOVEL TECHNIQUE OF SHORT-ACTING SPINAL ANAESTHESIA FOR FRACTURE NECK OF FEMUR SURGERY ALLOWING EARLY MOBILIZATION, REDUCING MORBIDITY AND MORTALITY, AND IMPROVING OVERALL FUNCTIONAL OUTCOME

Prompt mobilisation after the Fracture neck of femur surgery is one of the important key performance index (‘KPI caterpillar charts’ 2021) affecting the overall functional outcome and mortality. Better control of peri-operative blood pressure and minimal alteration of renal profile as a result of surgery and anaesthesia may have an implication on early post-operative mobilisation.Aim was to evaluate perioperative blood pressure measurements (duration of fall of systolic BP below the critical level of 90mmHg) and effect on the post-operative renal profile with the newer short acting spinal anaesthetic agent (prilocaine and chlorprocaine) used alongside the commonly used regional nerve block. 20 patients were randomly selected who were given the newer short acting spinal anaesthetic agent along with a regional nerve block between May 2019 and February 2020. Anaesthetic charts were reviewed from all patients for data collection. The assessment criteria for perioperative hypotension: Duration of systolic blood pressure less than 90 mm of Hg and change of pre and post operative renal functions.Only one patient had a significant drop in systolic BP less than 90mmHg (25 minutes). 3 other patients had a momentary fall of systolic BP of less than 5 minutes. None of the above patients had mortality and had negligible change in pre and post op renal function. Only one patient in this cohort had elevation of post-operative creatinine levels but did not have any mortality. Only 1 patient died on day 3 post operatively who had multiple comorbidities and was under evaluation for GI cancer. Even in this patient the peri-operative blood pressure was well maintained (never below 90mmHg systolic) and post-operative renal function was also shown to have improved (309 pre-operatively to 150 post-operatively) in this patient.The use of short-acting spinal anaesthesia has shown to be associated with a better control of blood pressure and end organ perfusion, less adverse effects on renal function leading to early mobilisation and a more favourable patient outcome with reduced mortality, earlier mobilisation, shorter hospital stay and earlier discharge in this elderly patient cohort.

Clinical profile and demographic distribution of pigment dispersion syndrome: An electronic medical record-driven big data analytics from an eye care network in India

Objectives: The purpose of this study was to describe the demographics and clinical profile of pigment dispersion syndrome (PDS) in patients presenting to a multi-tier ophthalmology hospital network in India. Material and Methods: This cross-sectional hospital-based study included 2,961,706 new patients presenting between August 2010 and September 2021. Patients with a clinical diagnosis of PDS in at least one eye were included as cases. The data were collected using an electronic medical record system. Results: Overall, 403 (0.014%) patients were diagnosed with PDS. Three fourth of the patients were male (75.43%) and 91.81% had bilateral affliction. The most common age group at presentation was during the fourth decade of life with 100 (24.81%) patients. In the 773 eyes, 443 (57.31%) eyes had mild or no visual impairment (&lt;20/70) and blindness (&gt;20/400) in 81 (10.48%) eyes. Krukenberg spindle was seen in 445 (57.57%) eyes and iris transillumination defects in 33 (4.27%) eyes. About a third of the eyes, 241 (31.18%) eyes had an intraocular pressure (IOP) &gt;21 mm of Hg at presentation. Three hundred and twenty-eight (42.43%) eyes were on more than one anti-glaucoma medication. YAG peripheral iridotomy was documented in 100 (12.94%) eyes. In the 46 (5.95%) eyes that required a glaucoma related surgical intervention, combined surgery was performed in 30 (3.88%) eyes and trabeculectomy in 16 (2.07%) eyes. Conclusion: PDS is more common in males presenting during the fourth decade of life and is predominantly bilateral. A third of the eyes have raised IOP and a tenth of them are affected with blindness at presentation.

The effect of progressive muscle relaxation technique on physical parameters and anxiety among patients with myocardial infarction

The main aim of the study is to assess the effect of progressive muscle relaxation therapy on physical parameter and anxiety among patient with myocardial infarction admitted at selected hospitals of Durg (C.G). The study was conducted at B.M Shah Hopsital and K. Gurunath Cardiac Hospital for patient with myocardial infacrtion.Quasi experimental pretest posttest control group design was adopted for this study. Convenient sampling technique was used to select the study participants. The patient with myocardial infarction was assigned to experimental group (n=23) and the other to the control group (n=23). Progressive muscle relaxation therapy was given for 20 minutes once daily in the morning between 6-8AM for 7 days. Physical parameter and anxiety measurements were taken from the first day and 7 day and was documented. The study showed a significant reduction of physical parameters mean blood pressure from 5.75 to 5.5 mm of Hg, for pulse 5.5 to 5, for respiration 7 to 5.7, and SPO2 7 to 5.8. calculated ‘t’ value was greater than the table value at 0.001 level of significance. Level of anxiety before and after progressive muscle relaxation among the experimental group was 50and 44.5. respectively. Standard deviation was 7.0, 6.6 and the calculated ‘t’ value was 3.4. While comparing with table value, it showed that the calculated ‘t’ value was greater than the table value at 0.001 level of significance.Hence it is concluded that progressive muscle relaxation therapy is an effective measure to maintain the level of physical parameters and reduce the level of anxiety among patient with myocardial infarction at selected hospitals of Durg (C.G).

Excess Global Blood Pressure Associated With Fine Particulate Matter Air Pollution Levels Exceeding World Health Organization Guidelines

Excess Global Blood Pressure Associated With Fine Particulate Matter Air Pollution Levels Exceeding World Health Organization Guidelines

Effect of Ayurveda Protocol (Nasya, Pindi, Bidalaka &amp; Anjana) in Intra Ocular Hydrops – A Pilot Study

Normal Intra Ocular Pressure (IOP) ranges from 14 – 21 mm of Hg. Intra-Ocular Hydrops is an asymptomatic condition with raised Intra Ocular Pressure without any visual impairment or comorbidities. Altered Intra Ocular Pressure above / below normal level with associated visual symptoms &amp; optic neuropathy are referred to as glaucoma. Intra Ocular Hydrops population is at greater risk of developing glaucoma. They remain unnoticed and undiagnosed most of the time for a longer duration or advancement of the condition. Early diagnosis and timely management prevent the progression of the disease to Primary Open Angle Glaucoma and other conditions. Proven Ayurvedic treatment modalities are not available for Intra Ocular Hydrops. In such a scenario, considering the multifactorial involvement, an Ayurvedic protocol containing different treatment modalities was developed and its effect was studied. Materials &amp; Methods: 100 patients were screened from the eye Out Patient Department of institute. 10 Patients who fulfilled the inclusion criteria were enrolled and analysed for results. Ayureda Protocol was administered (Table 1) which included an in Patient Department basis for Nasya, Pindi and Bidalaka for a period of 11 days and Anjana for a period of 30 days. The assessment of Intra Ocular Pressure was done with the help of Goldman’s Applanation Tonometry. The assessment was done on 0th day (BEFORE TREATMENT), 11th day (AT), 26th day (FU1) and 41st day (FU2). Results: For statistical analysis T test was used was used. Within the group, there was a significant reduction of Intra Ocular Pressure with a p-value &lt;0.0001. Conclusion: There was significant reduction in the values of Intra Ocular Pressure and a nearly normal value was achieved as target Intra Ocular Pressure.

CLINICAL PROFILE AND PREDICTORS OF ATRIAL FIBRILLATION IN ACUTE MYOCARDIAL INFARCTION: AN OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL

Background and aims: Acute myocardial infarction (AMI) frequently results in atrial brillation, which has a documented incidence ranging from 2.3 to 21%. This paper aims to evaluate the incidence of atrial brillation in a setting of myocardial infarction and the effect of this arrhythmia on the outcome. Materials and methods:This institution - based observational study was conducted on 110 patients attending the different units of Medicine Department and Cardiology Department of Gauhati Medical College and Hospital during the period from 1ST July 2021 to 30th June 2022. All patients had undergone Routine blood investigations, 12 – lead ECG, 2D ECHO, Serum Electrolytes, Cardiac Markers Results: the study showed that 9 patients out of 110 had new onset atrial brillation in the hospital course i.e. in this study overall incidence of AF in AMI is 8.18% of which, 44.4% succumbed to death. Incidence of AF in AMI in patients with age ≥60 years is 13.33%. Conclusion: The occurrence of AF in a setting of AMI is worth studying as there are numerous challenges in the management and follow up of these groups of patients. Elderly individuals, patients with tachycardia (HR&gt;100/min), hypotension (SBP&lt;100 mm of Hg) and heart failure with Killip class ≥3 are more prone to develop AF after AMI

Development of PR Restenosis after Percutaneous Balloon Pulmonary Valvuloplasty

Background: Pulmonary stenosis is not an uncommon congenital heart disease in our population. Various age groups present with severe pulmonary stenosis require intervention either surgical or percutaneous catheter-based. Often lifesaving surgical intervention is not feasible considering procedural risk, the patient’s physical condition, and young age. Percutaneous balloon pulmonary valvuloplasty is safe, effective, almost painless, economical, and less hospital stay in any age group with immediate and long-term success. This study aimed to analyze the rate of development of (Pulmonary Regurgitation) PR restenosis after Percutaneous Balloon Pulmonary Valvuloplasty (PBPV). Material Methods: This hospital-based prospective observational study was conducted in the Department of Paediatric Cardiology Combined Military Hospital (CMH), Dhaka from January to December 2021. 0-18 years aged 50 population with PS who were referred to the Paediatric Cardiology Department of CMH Dhaka during the study period were selected as study subjects as per inclusion criteria. The purposive Sampling technique was used in this study. Data were collected with a predesigned standard data collection sheet. Statistical significance was set as a 95% confidence level at a 5% acceptable error level. Categorical variables were expressed as frequency and percentages. Mean, standard deviation, and/or medians with interquartile ranges were used to express the continuous variables. Paired t-test was performed in categorical comparison. A p-value of &lt;0.05 was considered statistically significant. Collected data were analyzed using SPSS Version 24. Written informed consent was taken from every parent. Ethical clearance was taken from the Ethics Review Committee of CMH Dhaka for conducting the study. Results: 50(6.39%) had isolated valvular PS. The international standard for the prevalence of isolated PS is 8-10% which is very close to this study’s result. In this study, male predominance was found with the male-female ratio of 3:2 though there was no gender dominance found in other studies. Out of 50 cases, 3(6%) are neonates,7(14%) are infants, 27 (54%) are 1-5 years aged, and 13(26%) are more than 5 years aged. A total of 13(26%) cases developed PR, and all 13 patients developed trivial PR on D1 echo, out of them 1 patient developed mild PR on D30 Echo but in D90 and D180 Echo patients persisted the same mild PR. Out of 50 cases, 46(92%) were successful and 4 cases were procedure failed. None of the successful cases developed restenosis. Out of 4 procedure failed cases 1 patient developed restenosis on D30 follow up and 2 patients develop restenosis on the D90 follow-up. At D180 follow up none of the patients developed restenosis. All the restenosis cases had dysplastic pulmonary valves. One patient’s PS gradient persisted at 30-50 mm of Hg throughout the follow-up period. Overall restenosis in 180-day follow-up is 3(6%) and the remaining 47(94%) cases lead a healthy life in 6 months follow-up. Reballooning was done immediately after diagnosis of restenosis in stenosed cases. Conclusion: Immediate and intermediate-term (6 months) follow-up with Doppler echocardiography showed excellent outcomes in all cases except 3 (6.0%) restenosis cases and 13 (26.0%) insignificant PR cases. The baby who all had restenosis, had the risk factor, like- dysplastic PV. It may be concluded that balloon valvuloplasty is the procedure of choice for moderate, severe, and critical pulmonary valve stenosis.

Comfort and Support Values Provided by Different Pillow Materials for Individuals with Forward Head Posture

Based on the pressure distributions in the head, neck, and upper body and the spine support values, this study aims to recommend the most suitable pillow for those with forward head posture (FHP) according to different sleeping positions. This descriptive cross-sectional study recruited thirty healthy 18- to 55-year-old men and women with body mass indexes of less than 30 kg/m2. Participants tried five different pillows (viscose, fiber, cotton, goose feather, and wool) on a medium-firm hybrid mattress at room temperature with a humidity of 45–55%. Participants tried the pillows first in the supine position, then side-lying, and finally in the prone position. A pressure-mapping system was utilized to measure the pressure distributions of the head and shoulder areas in millimeters of mercury (mmHg) and the amount of support provided by the pillow to these regions in square centimeters (cm2). When the comfort and support parameters of different pillow materials were compared among all participants, for the supine position, Pillow B and Pillow E provided higher head comfort (p &lt; 0.001), while Pillow A and Pillow E provided higher shoulder support (p = 0.044). In the side-lying position, Pillow B provided higher head comfort (p &lt; 0.001) and Pillow C (p = 0.003) higher shoulder comfort. In the prone position, Pillow B and Pillow E provided higher head comfort (p &lt; 0.001), while Pillow E also provided higher shoulder support (p = 0.002). This study showed pillow materials affect the spine comfort and support of the participants, and these values may vary according to different spinal alignments, such as FHP. According to the preferred sleeping position, the pillow material that supports the spine and its comfort and support values may also change.

Toward IoT-Based Medical Edge Devices: PPG-Based Blood Pressure Estimation Application

The Internet of Things (IoT) now provide a considerable advantage in terms of intelligent devices. For example, sensor data of medical equipment could be used to extract meaningful insights to enable a range of tasks to be performed intelligently at the device location, such as blood pressure (BP) prediction several minutes ahead. In this article, we propose a computing device called Medical Edge, designed to convert conventional medical equipment into IoT-enabled devices. We developed an interworking proxy that allows Medical Edge to be interfaced with medical devices, such as patient monitors (e.g., GE CARESCAPE B650), to smoothly collect physiological data and upload them to an IoT server platform. We used a oneM2M standard-based server platform to provide access to these data in a standardized manner. To demonstrate a promising application of our proposed Medical Edges, we performed a study on BP estimation based on photoplethysmography (PPG) signal only. We propose a hybrid neural network architecture and apply it with a publicly available data set called multiparameter intelligent monitoring in intensive care II (MIMIC II). The model consists of five 1-D convolutional neural networks (CNNs), three Bi-directional long short-term memory networks, and four fully connected layers. The mean absolute error (MAE) and standard deviation (STD) of the proposed model were, respectively, 0.95 and 1.44 millimetres of mercury (mmHg) for diastolic BP (DBP), and 1.38 and 2.13 mmHg for systolic BP (SBP). The experimental results are in full compliance with the international standards of the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS).

Effectiveness of a Disease Management Program (DMP) in controlling the progression of Chronic Kidney Disease among hypertensives and diabetics.

Background: In India, the number of patients with type II diabetes mellitus in 2006 was 40.9 million and is expected to increase by 2025 to 69.9 million. The occurrence rate of stage 5 CKD was 151 per million population in India. Diabetes Mellitus and hypertension were the usual triggers of Chronic Kidney Disease (CKD). A structured education program helps in the prevention of diabetes and hypertension related complications. Methods: This quasi-experimental study was conducted among 88 participants who had hypertension, diabetes mellitus, or both for five or more years with an objective to find the effect of a Disease Management Program on delaying progression of CKD in patients with hypertension or diabetes mellitus. The baseline data were collected on demographic proforma, serum creatinine, blood pressure, and random blood sugar, and the patients were taught the management of hypertension and diabetes mellitus. In the fourth and the eighth month, blood pressure and blood sugar were reassessed. At one-year blood pressure, blood sugar, and serum creatinine were tested. Baseline and one-year follow-up blood pressure, blood sugar, and estimated Glomerular Filtration Rate were compared. Descriptive statistics and "Wilcoxon signed-rank test" were used to analyze the data. Results: In one year, the mean systolic blood pressure reduced by six mm of Hg and mean blood sugar by 24 mg/dl. The prevalence of CKD stage three and above (&lt; 60 ml/min/m2) was nine (10.22%). The median decline in eGFR was 5 ml/min/m2 (Z= 5.925, P&lt; 0.001). Conclusion: The Disease Management Program led to improvements in blood pressure and diabetes control and median progression of CKD was estimated at five ml/min/m2/year.

Impact of Intracranial Pressure-Monitored Therapy on Mortality in Patients with Severe Traumatic Brain Injury

Objective: To assess the impact of intracranial pressure (ICP) monitored therapy on mortality in patients with severe traumatic brain injury.&#x0D; Materials and Methods: A randomized controlled trial was conducted at the Department of Neurosurgery, Jinnah Hospital Lahore. Forty patients of both genders, aged between 15 to 60 years were randomly selected and divided into two groups (Control &amp; Experimental). Patients injured within 24 hours with a Glasgow Coma Scale (GCS) of 8 or less and showing radiological evidence of raised intracranial pressure were included. Patients with extradural hematoma, penetrating injury, or those requiring any surgery were excluded from the study. Data were analyzed using SPSS version 20.&#x0D; Results: No significant difference was found in mean age and gender among the two groups. The GCS of the control group was 6.2 ± 1.6 while that of the experimental group was 6.7 ± 1.6. The mean of the maximum ICP of the experimental group was 25.31 ± 8.48 mm of Hg. There was a significant difference in the mean duration of ventilation between the two groups. In the control group, 10 (50.0%) patients expired whereas in the experimental group, 8 (40.0%) patients expired. The proportion of mortality was higher in the control group but the difference was not statistically significant between the two groups (P value: 0.525).&#x0D; Conclusion: Intracranial pressure-monitored therapy was effective but statistically showed no significant superiority over unmonitored management.

Multiple Trajectories of Body Mass Index and Waist Circumference and Their Associations with Hypertension and Blood Pressure in Chinese Adults from 1991 to 2018: A Prospective Study.

Body mass index (BMI) and waist circumference (WC) have been suggested to be involved in the etiology of hypertension. The present study aimed to determine multiple trajectories of BMI and WC, then examined their associations with the risks of hypertension and high blood pressure in Chinese adults. The study used China Health and Nutrition Survey data from 1991 to 2018. The sample included 9651 adults aged 18 years or older. We used group-based multi-trajectory modeling to identify trajectories. We estimated the relationships between the trajectories and the risks of hypertension with a Cox proportional hazards regression model and the trajectories' relationships with blood pressure levels with a generalized linear model. We identified four trajectories for each gender: low stable BMI, low increasing WC (group 1); medium increasing BMI, medium increasing WC (group 2); increasing BMI to overweight, increasing WC to central obesity (group 3), increasing BMI to obesity, increasing central obesity WC (group 4). Group 1 was the reference group. Among males in groups 2, 3, and 4, the adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) of hypertension were 1.30 (1.15-1.48), 1.86 (1.58-2.18), and 2.60 (2.02-3.34), respectively. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of males in group 4 increased by 11.90 mm of mercury (mmHg) and 7.75 mmHg, respectively. Among females in groups 2, 3, and 4, the HR and 95% CI of hypertension were 1.35 (1.18-1.54), 1.92 (1.62-2.26), and 2.37 (1.85-3.03), respectively. The SBP and DBP of females in group 4 increased by 8.84 mmHg and 5.79 mmHg, respectively. These data indicated that increases in BMI and WC were associated with unfavorable hypertension risks. Attention to both BMI and WC trajectories has the potential to prevent hypertension.

TO STUDY THE EFFICACY OF PROPHYLACTIC INTRAVENOUS PHENYLEPHRINE IN PROPOFOL-INDUCED HYPOTENSION DURING INDUCTION OF GENERALANAESTHESIA

INTRODUCTION :Hypotension is the most common complication during induction of general anesthesia. Hypotension is the decrease in systolic blood pressure below the normal accepted value, that is less than 90mm of Hg or decrease in mean arterial pressure of less than 65 mmHg. It is asymptomatic while induction of anesthesia and recognition requires proper predictors on multipara monitors like systolic blood pressure and mean arterial blood pressure. To prevent hypotension many methods like co-loading with intravenous crystalloids, vasopressors have been tried. In our study we are using prophylactic intravenous phenylephrine to prevent fall in blood pressure and to measure the SBPand MAPafter induction of anaesthesia and intubation in the study and control group. (At 5 minutes, 10 minutes, and 15 minutes)” METHODOLOGY-The study was conducted at “Dr. D. Y. Patil medical college, hospital, and research institute” from March 2021 to August 2022 after institutional ethical approval. Total of 120 patients were selected and were divided into two groups, the study group (n =60) the control group (n =60). Routine systematic preoperative assessment and investigation were performed according to the study protocol. RESULTS- SBP was observed to be signicantly declined in the “control group” compared to the “study group” when observed at 10min and 15min time intervals. MAPwas found to be effectively reduced in the “control group compared to the “study group” when observed at 10 min and 15min time intervals. CONCLUSION-From the study it was concluded that the “prophylactic intravenous phenylephrine is effective in preventing fall in blood pressure associated with propofolinduced hypotension at the time of induction during general anaesthesia”

Evaluation of Left Atrial Size in Patients with Hypertension with Left Ventricular Hypertrophy in a Tertiary Care Hospital of Nepal

Background: The hypertensive heart disease is characterized by left ventricular hypertrophy (LVH), atrial remodeling and AF. The impact of hypertension on the left atrium is little known. LVH is a link between hypertension and left atrium enlargement (LAE). LAE raises the suspicion of increased BMI, DM, dyslipidemia in hypertension. Thus, the aim of this study is to evaluate the LA size hypertensive patients without metabolic disorder and to evaluate whether there is a relationship between LVH and LAE. Methods: This is a prospective, observational study conducted in SGNHC, Kathmandu, Nepal. Our Study included 91 hypertensive patients fulfilling inclusion criteria from August 2021 to January 2022. Results: 91 patients were enrolled for the study, out of which 50 (54.9%) were males and 41 (45.1%) were females. Mean age of patients was 47.77±12.1 years. 23(25%), 28(31%) and 40 (44%) patients fulfilled SV3+RaVL, SV1+RV5, RaVL criteria respectively of LVH. 10(11%),12 (13%) and 25(27.5%) satisfied the criteria of LVMI, IVSD, RWT respectively. The mean values of LA diameters, area, volume and volume Index were calculated. There were a significant associations between left ventricular internal diameters and age with LAVI (p-value &lt;0.05). There was a mild positive association between SBP more than 140mm of Hg and LAVI, although not significant statistically. Similarly, there was a significant association between increased BMI above 25 and LAVI more than 34. Conclusion: LAE is associated with LV diameter, age, BMI and SBP. J Inv Clin Cardiol 2023; 5(1): 19-23

Dietary patterns and indicators of cardiometabolic risk among rural adolescents: A cross-sectional study at 15-year follow-up of the MINIMat cohort.

Diet being a modifiable factor, its relationship with cardiometabolic risk is of public health interest. The vast majority of studies on associations of dietary patterns with cardiometabolic risk indicators among adolescents are from high-income countries and urban settings. We sought to describe dietary patterns and examine their associations with selected cardiometabolic risk indicators-waist circumference (WC), systolic blood pressure, fasting lipid profile and insulin resistance-along with its gender stratification among adolescents in a low-income, rural setting. This cross-sectional study utilized data from the 15-year follow-up of the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort in southeast Bangladesh. The children who were born as singletons to the mothers randomized in the MINIMat trial and had valid birth anthropometrics were eligible for the follow-up. We employed a single, qualitative 24-hour recall to assess diet. Dietary patterns were derived from simple K-means cluster analysis, and calculation of dietary diversity score (DDS) using a validated instrument. Anthropometric parameters and systolic blood pressure were recorded. Fasting plasma triglyceride, total cholesterol, low- and high-density lipoproteins, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Three right-skewed outcome variables were natural log (Ln) transformed: WC, triglyceride and HOMA-IR. Omnibus and gender-specific multiple linear regression models were fitted. Among 2,253 adolescents (52.1% girls, 7.1% overweight/obese), we identified four diet clusters: Traditional, Fish-dominant, Meat-dominant, and High-variety. No significant associations were found between the clusters and indicators. On gender-stratification, triglyceride levels were lower among boys in the Fish-dominant (Ln-triglyceride βadjusted: -0.09; 95% confidence interval (CI): -0.15, -0.02) and Meat-dominant (Ln-triglyceride βadjusted: -0.08; 95% CI: -0.15, -0.004) clusters than among boys in the Traditional cluster. Compared to boys in the bottom quartile of DDS, boys in the top quartile had 2.1 mm of Hg (95% CI: 0.5, 3.6) higher systolic blood pressure and 1.9% (95% CI: 0.01-3.8%) higher WC. While statistically significant, the gender-specific differences in triglyceride, systolic blood pressure, and waist circumference across dietary patterns were small. Associations between dietary patterns and cardiometabolic risk indicators may require a time lag beyond mid-adolescence to manifest in a rural setting. Prospective studies are warranted to delineate the magnitude and direction of those associations.

Comparison of intraocular pressure and retinal nerve fibre layer thickness in pre-menopausal and post-menopausal women attending outpatient department of BSMMU

In a menopausal lady, a reduced level of estrogen hormone leads to changes in the intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness in the eyes. This comparative study was carried out in the Outpatient Departments (OPD) of the Community Ophthalmology and Ophthalmology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from April 2017 to June 2019 to identify any difference in IOP and RNFL thickness in pre-menopausal and post-menopausal women aged 40-65 years. In this study, 60 pre-and post-menopausal women were included. Participants 40-50 years old with irregular menstruation were classified as group A, while those 51-65 years old with no menstruation for at least 12 months were classified as group B. More than one-fourth (26.7%) of participants had HTN in group A and 53.3% in group B. HTN was significantly associated with group B. The rise in menopausal age had a significant impact on the mean IOP and RNFL. The mean IOP in right eye (RE) was 11.80 (3.31) mm of Hg in Group A and 15.63 (3.01) mm of Hg in Group B. The mean IOP in left eye (LE) was 12.27(3.78) mm of Hg and 15.47(2.84) mm of Hg in Group A and Group B, respectively. The mean IOP of both eyes was 12.03±3.48 mmHg in Group A and 15.55±2.82 mmHg in Group B. The mean difference of IOP in RE, LE and both were statistically significant between the two groups. The mean RNFL in RE was 103.97±7.42 μm in Group A and 98.90±}6.21 μm in Group B. The mean RNFL in LE was 101.87±6.69 μm and 97.97±6.65 μm in Group A and Group B, respectively. The mean RNFL of both eyes was 102.92±7.77 μm in Group A and 98.45±7.86 μm in Group B. The mean RNFL was statistically significant between the two groups. Post-menopausal women are at an increased risk of developing elevated IOP and thin RNFL than premenopausal women. BSMMU J 2022; 15(2): 61-64