SummaryBackgroundStudies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care.MethodsThis study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366.Findings1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, −3·5 mm Hg [95% CI −5·8 to −1·2]; telemonitoring, −4·7 mm Hg [–7·0 to −2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference −1·2 mm Hg [95% CI −3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups.InterpretationSelf-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care.FundingNational Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK.

Several epidemiological studies conducted on thousands of underground miners suggest that long- term exposure to high radon concentration can increase the risk of lung cancer. Keeping in view the importance of the subject, numerous studies throughout the world have been carried out to measure indoor radon concentration and its resulting doses at occupational and non-occupational sites. The purpose of the current study was to measure indoor radon concentration and its resulting doses received by the students of Azad Kashmir government schools. For this purpose, CR-39 radon detectors were installed in 80 carefully selected schools. The detectors were placed at a height of 3-5 ft. (depending upon average height of students in particular class) from the ground. After exposure of 90 d detectors were etched for 9 h in 6 M NaOH at 70°C and the observed track densities were related to radon concentrations. The measured indoor radon concentration ranged from 22 ± 9 to 228 ± 3 Bq m(-3) with a mean value of 78 ± 5 Bq m(-3). Based on the measured indoor radon data, the annual effective doses were found to vary from 0.55 ± 0.04 to 0.71 ± 0.03 mSv y(-1). The overall mean effective dose for the studied area was found to be 0.63 ± 0.04 mSv y(-1). Reported values for radon concentrations and corresponding doses are lower than ICRP recommended limits for workplaces.

There is ever increasing problem of air pollution in cities due to urbanization, industrialization, population growth and increased number of vehicles. Plants can play a vital role in mitigation of air pollution in urban areas. The present study was conducted to estimate the Air Pollution Tolerance Index (APTI) and Anticipated Performance Index (API) for 21 different plant species used for green belt development along the roadsides in Islamabad, the capital city of Pakistan. For APTI and API estimation, ascorbic acid, total chlorophyll content, relative water content and pH of leaf extract of selected plant species were measured using standard methods. The results showed that Syzygium cumini L. (jaman), Pterospermum acerifolium (kanak champa) and Alstonia scholaris (devil tree) were the excellent performers. According to API and APTI values, these species were found effective in reducing air pollution and could be effective for green belt development in urban areas. Albezia lebbeck, Melia azedarach, Eucliptus camaldulensis, Dalbergia sissoo, Tamarindus indica, Acacia nilotica L., Callistemon viminalis and Leucaena leucocephala are very poor performers regarding air and noise abatement. These plants are very poor performers and are very sensitive plants to air pollution. These plants can be used as bio-indicators of poor urban air quality.

No abstract

Chewed calcium carbonate (CaCO3) rapidly neutralizes esophageal acid and may prevent reflux, suggesting another mechanism of action independent of acid neutralization. Calcium is essential for muscle tone. Our aim was to determine if luminal calcium released from chewed antacids improved esophageal motor function in heartburn sufferers. Esophageal manometry and acid clearance (swallows and time to raise esophageal pH to 5 after a 15-ml 0.1 N HCl bolus) were performed in 18 heartburn sufferers before and after chewing two Tums EX (1500 mg CaCO3, 600 mg calcium). Subjects with hypertensive esophageal contractions or hypertensive lower esophageal sphincter pressure (LESP) were excluded. Subjects with normal to low LESP were included. Differences between parameters were determined by two-tailed paired t-tests, P < 0.05. Proximal esophageal contractile amplitude was significantly increased after CaCO3 (47.18 vs 52.97 mm Hg; P = 0.02), distal onset velocity was significantly decreased after CaCO3 (4.34 vs 3.71 cm/sec; P = 0.02), and acid clearance was significantly increased 30 min after CaCO3 (20.35 vs 11.7 swallows, [P < 0.005] and 12.19 vs 6.29 min [P < 0.007]). LESP was not altered after CaCO3 (22.70 vs 23.79 mm Hg; P = 0.551), however, LESP increased in 9 of 18 subjects. Depth of LES relaxation, medial and distal esophageal contractile amplitude, and duration of contractions were not altered by CaCO3. CaCO3 did not alter salivary secretion and pH in a subset of these subjects, and CaCO3 with secreted saliva did not neutralize a 15-ml acid bolus. The Ca2+ released after chewing of CaCO3 antacids may be partially responsible for the reduction of heartburn by significantly improving initiation of peristalsis and acid clearance.

Background: Type 2 diabetes mellitus is a common metabolic disorder of multiple etiologies. Increased levels of serum ferritin have been indicated to be associated with the etiology of the diabetic process, as well as in pathogenesis of various diabetic complications. The study aims to understand the relationship between the serum ferritin and glycated hemoglobin in type 2 diabetes mellitus. Subjects and Methods: The study was conducted at Medical College Hospital and Research Centre. A total of hundred cases of type 2 diabetes mellitus of the age group 30 -70 years were taken for the study after satisfying the inclusion and exclusion criteria. Hundred healthy volunteers in the age group 30 -70 years, sex matched during the same period was included in the study under the control group. Results: Serum ferritin level was significantly high in cases compared to controls. There was moderate correlation between serum ferritin and glycated hemoglobin. There was significant increase in serum ferritin levels in type 2 diabetics compared to the controls. There was a moderate correlation between serum ferritin and glycated hemoglobin. Conclusion: This study explores the possibility of finding serum ferritin as a marker to explain the oxidative stress process in type 2 diabetes mellitus. This valuable information would be helpful in proper medical intervention.

The improvement of adolescent nutritional status may help address the reduction of all forms of malnutrition in Bangladesh. This is because at this stage, they experience a growth spurt thus increasing the need for most nutrients, needed for growth and reproductive health. The objective of this research was to assess the nutritional status of adolescent girls in rural areas of Bangladesh and find out the associated factors that affects nutritional status. A cross sectional study was carried out among 106 adolescent girls of Nobabpur village in Comilla district. A questionnaire was developed to obtain demographic information, food intake pattern and anthropometric measures such as weight, height with measuring instruments. About 80% were found normal according to BMI where about 13% adolescent girls were malnourished, below the cut off value 18.5. Place of residence, education of adolescent girls, their family expenditure to food and improper knowledge on food and nutrition were identified as underlying causes. Nutritional profiles of adolescent girl can be improved by implementing effective nutrition education program, providing supplementary food, facilitating primary health care program and creating awareness about nutritional knowledge. Severely malnourished adolescent girl in the selected area should be identified as early as possible and brought under supplementary feeding program.

During present study, the copper (Cu) mediated oxidative stress was measured that induced DNA damage by concentrating in the tissues of fish, Catla catla (14.45±1.24g; 84.68±1.45mm) (Hamilton,1822). Fish fingerlings were retained in 5 groups for 14, 28, 42, 56, 70 and 84 days of the exposure period. They were treated with 2/3, 1/3, 1/4 and 1/5 (T1-T4) of 96h lethal concentration of copper. Controls were run along with all the treatments for the same durations. A significant (p < 0.05) dose and time dependent concentration of Cu was observed in the gills, liver, kidney, muscles, and brain of C. catla. Among organs, the liver showed a significantly higher concentration of Cu followed by gills, kidney, brain, and muscles. Copper accumulation in these organs caused a significant variation in the activities of enzymes viz. superoxide dismutase (SOD), catalase (CAT) and peroxidase (POD). The SOD activity varied significantly in response to the exposure time of Cu as 56 > 70 > 42 > 84 > 28 > 14 days while CAT activity exhibited an inverse relationship with the increase in Cu concentration. POD activity showed a significant rise with an increase in Cu exposure duration. Comet assay exhibited significant DNA damage in the peripheral erythrocytes of Cu exposed C. catla. Among four exposure concentrations, 2/3rd of LC50 (T1) caused significantly higher damage to the nuclei compared to control. Increased POD and SOD activity, as well as a decrease in CAT activity in response to Cu, demonstrates the involvement of a protective mechanism against reactive oxygen species (ROS), whereas increased ROS resulted in higher DNA damage. These above-mentioned molecular markers can be efficiently used for the biomonitoring of aquatic environments and conservation of edible fish fauna.