Background: Rapid urbanization of rural areas is predicted to increase the incidence of risk factors for vascular events such as stroke among the ruralites. A different culture, beliefs, terrain, and climatic conditions of Himachal Pradesh may have an impact on the profile of stroke. Objectives: To study the profile and the various risk factors of stroke in the sub-Himalayan region of north India.
INTRODUCTIONCardiovascular Disease has so far accounted for nearly half of all deaths in the developed world and 25 percent of deaths in the developing countries. By 2020 it has been projected that there will be an increase by almost 75 percent in the global CVD. 1 CVD has assumed epidemic proportions in India. These epidemics are driven by socioeconomic changes that have profound effects on life style. Urbanization, Industrialization and especially globalization propelled developing countries into the worldwide epidemic of CVD. There is a strong positive correlation in the increase in CHD in India with risk factors like diabetes, hypertension, dyslipidemia, metabolic syndrome, smoking and sedentary lifestyle. The conventional risk factors can be modifiable and nonmodifiable. Age and gender are non modifiable risk factors for coronary artery disease. Heart diseases are far more age dependent in women than in men. ABSTRACTBackground: Coronary events presents about ten years later in women than men. There exist distinct gender differences in terms of presentation of symptoms, validity of diagnostic tests and complications. Methods: The study was conducted in the department of medicine R.P. Govt. Medical College (RPGMC) Himachal Pradesh. Consecutive 300 patients of acute coronary syndrome from June 2011 to June 2012 were included in the study. Demographical profile was recorded with focused clinical examination and relevant investigation with lipid profile was done. Results: Among the study population of 300 individuals, 201 (67%) were males and 99 (33%) were females. The mean age among male patients was 61.3±11.7 years and in female patients the mean age was 65.6±11.20 years. 68.8% of females presented after 60 yrs of age. Dyslipidemia was the commonest risk factor followed by hypertension and obesity. 12.2% of female patients were smokers. Chest pain was the commonest presenting symptom seen in 82% cases. There was mean delay of 31.0±54.5 hrs in the presentation of females for treatment. ST Elevated Myocardial Infarction occurred less frequently in females. Conclusions: Acute coronary syndrome is more age dependent in females. The predominance of dyslipidemia, hypertension and obesity as risk factors gives a message for primary care physicians to create awareness for the prevention of Acute Coronary Syndrome. The atypical symptoms should be recognised early which should further prevent the delay in presentation.
BACKGROUND: To determine the efficacy of streptokinase in diabetic versus non-diabetic patients presenting with acute ST Elevation Myocardial Infarction (STEMI). METHOD AND RESULTS: This is a hospital based observational study conducted in the department of Cardiology, S.M.S. MEDICAL COLLEGE and associated hospital, Jaipur, Rajasthan between March 2016 to August 2017. Two hundred one consecutive patients of acute STEMI admitted to the Cardiology department were enrolled in the study to maintain 95% CI and 80% power of study. Patients with acute STEMI within 12 hours of chest pain without contraindications to fibrinolytic therapy (streptokinase) were included. ECG was done before and at 90 minutes after the start of streptokinase. ST-segment resolution equal to or more than 70% at 90 minutes on ECG was taken as successful reperfusion. The data was analysed by using software SPSS version 10. The quantitative variables were presented as mean and standard deviation while qualitative variables as frequency and percentage. Chi square test was used to estimate significance and p-value of <0.05 was considered significant. Out of 201 patients, 127(63.2%) were non-diabetics and 74(36.8%) were diabetics. The age of presentation of these patients was 32-75yr (meanage=55.59yr). Of these patients, 80% (N=160) were male and 20% (N=40) were female. Among the 74 diabetic patients, streptokinase was not effective in any patients. So streptokinase is non-efficacious in diabetic patients. Among the 127 non diabetic patients, streptokinase was effective in 79 (62.2%). Among the risk factors, smoking and hypertension were found in 84.6% and 62.7% of the patients respectively. So, we found smoking as the most common risk factor followed by HTN and DM in our patients. HTN was found significantly more in diabetic patients (94.59%) vs (44.09% in non-diabetic patients). On angiography, 58.7% patients had SVD, 34.8% had DVD and 6.5% had TVD. Five (2.5%) of these were found to have LM disease. Coronary angiography showed SVD, DVD, TVD in 44(59.46%), 17(22.97%) and 13(17.57%) of diabetic vs 74(58.27%), 53(41.73%) and 0(0%) of non-diabetic patients. So, triple vessel disease is significantly higher in diabetic patients. CONCLUSION: This study shows that streptokinase is significantly more efficacious in non-diabetics as compare to diabetic patients presenting with acute STEMI. It is more efficacious in male than female (M=47.82%; F=5%). We found that the window period of presentation was significantly higher in diabetic patient because of atypical symptoms that may lead to a delay in seeking medical advice and streptokinase was significantly more efficacious in non-diabetics as compare to diabetic patients.
BACKGROUND- This study to nd out the prevalence of diabetic retinopathy (DR) among diabetic children with type 1 DM treated with insulin. METHODS -This is a cross-sectional study conducted on 100 children with type 1 DM from 1 to 16 years of age. All patients were subjected to full fundus examination and were then classied according to its results into patients with DR and patients without DR. RESULTS- The mean age of the patients was 9.42±1.31 years and 56.00% were males. DR was found in 10 (10.00%) patients, seven of whom had retinopathy in one eye and three had retinopathy in both eyes. Mild nonproliferative DR was found in 11 eyes and moderate DR was found in 2 eyes. CONCLUSION- The prevalence of DR was 10.0% among all studied patients and 6.50% among all studied eyes. The grade of retinopathy was directly related to the duration of DM, fasting blood glucose, and glycosylated hemoglobin levels.
BACKGROUND: The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with RHD (rheumatic mitral stenosis) and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation in patients who were in SR vs. in AF. METHODS AND RESULTS: This is a hospital based observational study conducted in department of cardiology, S. M. S. MEDICAL COLLEGE and associated hospital, Jaipur, Rajasthan; between march 2016 to august 2017. We prospectively studied clinical and echocardiographic parameters of LA/LAA in 303 consecutive patients with mitral stenosis who underwent trans-esophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age of the patients was 32.94 years. One hundred thirty seven (45.21%) patients were in atrial fibrillation and 166 (54.79%) patients were in sinu rhythm. We found a statistically significant difference in the age of presentation (29.16/33.93/36.68 Yr; P =0.006/<0.001), MVA (1.17/0.8/0.69 cm2; P=<0.001/0.024), LA diameter (39/47.24/50 cm; P=<0.001/<0.001), LAA emptying velocity (45/26.43/15 cm/sec; P=<0.001/<0.001) and EF (37.49/30.67/23.7%; P=<0.001/0.001) among the patients without spontaneous echo contrast /clot vs. with spontaneous echo contrast vs. with spontaneous echo contrast & clot. By using student t-test, we found that there was a statistically significant difference in age of presentation, BMI, MDG, LA diameter, LAA emptying velocity and EF in patients who were in sinus rhythm vs. atrial fibrillation (P<0.05). Incidence of spontaneous echo contrast was 68.67% vs. 91.97% in patients in sinus rhythm vs atrial fibrillation, while that of SEC & CLOT both was 4.22% vs. 33.58% in patients in SR vs AF. In a subgroup of the patients with LA/LAA clot, the LA diameter (55.14 : 49.98 CM; P=0.057) and the LAA emptying velocity ( 15.14 : 15.26 CM/Sec; P=0.923) were not significantly different among patients in SR vs in AF. CONCLUSION: In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.
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