Economic, dietary and other lifestyle transitions have been occurring rapidly in most South Asian countries, making their populations more vulnerable to developing Type 2 diabetes and cardiovascular diseases. Recent data show an increasing prevalence of Type 2 diabetes in urban areas as well as in semi-urban and rural areas, inclusive of people belonging to middle and low socio-economic strata. Prime determinants for Type 2 diabetes in South Asians include physical inactivity, imbalanced diets, abdominal obesity, excess hepatic fat and, possibly, adverse perinatal and early life nutrition and intra-country migration. It is reported that Type 2 diabetes affects South Asians a decade earlier and some complications, for example nephropathy, are more prevalent and progressive than in other races. Further, prevalence of pre-diabetes is high, and so is conversion to diabetes, while more than 50% of those who are affected remain undiagnosed. Attitudes, cultural differences and religious and social beliefs pose barriers in effective prevention and management of Type 2 diabetes in South Asians. Inadequate resources, insufficient healthcare budgets, lack of medical reimbursement and socio-economic factors contribute to the cost of diabetes management. The challenge is to develop new translational strategies, which are pragmatic, cost-effective and scalable and can be adopted by the South Asian countries with limited resources. The key areas that need focus are: generation of awareness, prioritizing health care for vulnerable subgroups (children, women, pregnant women and the underprivileged), screening of high-risk groups, maximum coverage of the population with essential medicines, and strengthening primary care. An effective national diabetes control programme in each South Asian country should be formulated, with these issues in mind.
Introduction: Postoperative hypertension after craniotomy is a common problem even when compared to other surgeries like cardiac surgeries (1). Correlation of vasoactive modulators in relation to increased stress response in Craniotomy has already been studied. (1) The role of oxidative stress in cellular damage in animal models of surgically induced brain injury has been investigated (2), but information from humans, is sparse. In this exploratory observational study, we examine the temporal profile of oxidative stress markers in patients undergoing supratentorial craniotomy procedures and correlate this to postoperative hypertension. Methods: After IRB approval, written consent was obtained from 16 patients. 3ml of blood was collected from all the patients for the measurement of oxidative stress markers {malondialdehyde (MDA), protein carbonyl, and nitrate} at different stated intervals. A standard protocol for anesthesia was used. Hypertension was defined as mean blood pressure more than 20% of the preoperative value.The arterial blood pressure was recorded in a computerized monitor at 5-minute intervals through out the study period. The data was then compared statistically using Student's independent sample t-test and Pearson's correlation co-efficient wherever necessary. Results: On the basis of mean difference of blood pressure between pre operative and at extubation period 11 patients had hypertension and 5 patients were normotensive. The mean± SD of oxidative stress markers and mean arterial pressure (MAP) in hypertensive and Normotensive patients were shown in the table Discussion: This study demonstrates that oxidative stress markers are elevated both during surgery and in the immediate postoperative period in a number of patients undergoing supratentorial craniotomies. This increase in markers correlates with their MAP. Further studies are in progress to determine if whether the increase in oxidative stress markers is a cause of effect of increased sympathetic activity causing postoperative hypertension.
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