The COVID-19 pandemic has posed signi cant concern revolves around the prolonged effects experien... more The COVID-19 pandemic has posed signi cant concern revolves around the prolonged effects experienced by a subset of individuals post-acute sequelae of SARS-COV-2 infection, termed long COVID. This study protocol outlines the methodology for a meta-analysis and systematic review with the objective of comprehensively assessing the prolonged effects of COVID-19 on the Indian population and determine the likely risk factors connected to the development and persistence of long COVID. A comprehensive search strategy will be employed across major databases. By combining data from various studies, the expected outcomes include a clearer understanding and documentation of long-term prevalence rates of COVID, symptom pro les, regional disparities, and potential determinants for long-term COVID conditions within the Indian population. The anticipated ndings will contribute to a re ned understanding of this condition, guiding healthcare interventions and future research endeavors aimed at mitigating the impact of the long COVID condition on the Indian population.
Evidence-based Complementary and Alternative Medicine, Oct 7, 2022
Introduction. COVID-19, a multisystem disease, has implications for various immunity and infectio... more Introduction. COVID-19, a multisystem disease, has implications for various immunity and infection biomarkers. Yoga (Y), meditation (M), and pranayama (P), and their combinations have shown positive changes on those biomarkers among other than COVID-19 patients and healthy people. So, we aimed to document the evidence of possible implication in a systematic way. Materials and Methods. We screened 84 full texts, published in the last ten years, from three databases, from which only 44 met the eligibility criteria, and then extracted the data related to demographic characteristics, intervention, results, and strengths and limitations in two MS-Excel grids, and then presented them in tables and gures. Furthermore, we carried out meta-analysis including subgroup and sensitivity analysis using a random e ects model of 11 RCTs and reported the mean di erence, heterogeneity, and p value with 95% CI and presented them with forest and funnel plots and the tables. Results. Twenty-ve biomarkers of 4023 participants (range, 15-413) from 13 countries, healthy and clinical, from both sexes above 18 years, and from mainly clinical settings, were reported. YMP intervention, in solitary or in di erent possible combinations with varied durations among clinical and pregnant (range, 960-4800 minutes) and healthy (960-8400 minutes, excluding two studies of 20 minutes only) participants, was reported. It was revealed that 25 biomarkers, nine among the apparently healthy, 14 among the patients, and two among the pregnant, changed favourably (p < 0.05). Furthermore, either in meta-or subgroup-analysis, mean di erences of IL-6 (-1.44 pg/ml) (95% CI) (-2.33, -0.55), (p 0.002, I 2 = 82%), Cortisol (-40.75 pg/ml) (95% CI) (-64.13, -17.38), (p 0.0006, I 2 = 87%), and TNF-α (-3.40 pg/ml) (95% CI) (-4.83, -1.98), (p < 0.0001, I 2 = 79%) showed statistically signi cant changes. Nonetheless, considerable heterogeneity and publication bias were observed among the studies. Conclusion. Although more than two dozens of biomarkers in individual studies showed favourable changes, only IL-6, Cortisol, and TNF-α produced signi cant combined results, even then with much less certainty. Further meta-analysis of biomarkers of COVID-19 patients is highly recommended. Registration: CRD42021283894.
QJM: An International Journal of Medicine, Jul 29, 2020
Coronavirus disease 2019 (COVID-19) is a novel virus with continuously evolving transmission tren... more Coronavirus disease 2019 (COVID-19) is a novel virus with continuously evolving transmission trends. Contact tracing and quarantining of positive cases are chief strategies of disease control that has been accepted globally, though scientific knowledge regarding household transmission of the COVID-19 through contact of positive case is sparse. Current systematic review was planned to assess global statistics and characteristics of household secondary attack rate (SAR) of COVID-19. Eligible articles were retrieved through search of-MEDLINE, SCOPUS and EMBASE for the period December 2019 to 15 June 2020. Search terms were developed to identify articles reporting household SARs in various countries. After initial screening of 326 articles, 13 eligible studies were included in the final evidence synthesis. We found that SAR varies widely across countries with lowest reported rate as 4.6% and highest as 49.56%. The rates were unaffected by confounders such as population of the country, lockdown status and geographic location. Review suggested greater vulnerability of spouse and elderly population for secondary transmission than other household members. It was also observed that quarantining and isolation are most effective strategies for prevention of the secondary transmission of the disease. Symptomatic status of the index case emerged to be a critical factor, with very low transmission probability during asymptomatic phase. Present review findings recommend that adequate measures should be provided to protect the vulnerable population as only case tracing and quarantining might be insufficient. It should be combined with advisory for limiting household contacts and active surveillance for symptom onset.
Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. ... more Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. We aim to study secondary attack rate (SAR) of COVID-19 in household contacts of pediatric index cases from Gujarat, Western Indian state. Methods For this cross-sectional study, details of 2412 paediatric patients were collected from Government records. Through stratified random sampling 10% (n = 242) of the patients were selected for the study and were telephonically contacted for obtaining the details of household secondary infection; 72 pediatric index cases having 287 household contacts were included in the study. The SAR in household contacts of pediatric index cases was 1.7% (95% CI: 0.74-4%). Majority of the index cases were males (94.4%) with 66% of the patients being admitted at various hospitals and isolation facilities (45%); 37% were home quarantine. Of 72, 50 (74%) cases were aged between 12 and 18 years. The family size of the index cases causing secondary infection was comparatively larger than index cases without secondary household infection (6.75 ± 2.3 versus 4.9 ± 1.9; P = 0.034). The household SAR from pediatric patients is low and is closely associated with the family size of the index cases. Hence, home quarantine should be advocated in smaller families with appropriate isolation facilities.
International journal of medical research and review, Oct 31, 2016
We aimed to determine the overall prevalence of coronary artery disease (CAD), atherosclerotic ri... more We aimed to determine the overall prevalence of coronary artery disease (CAD), atherosclerotic risk factors and clinical profile of patients with rheumatic heart disease (RHD) undergoing valvular interventions in Asian Indians. Method: This was an all comers, observational, prospective study of 757 rheumatic patients, who underwent coronary angiography (CAG) prior to percutaneous balloon valvulotomy, surgical valvular repair or replacement from July 2011 to December 2013. Among them who had significant CAD (stenosis ≥50%) (Group A), were compared with similar number of age and sex matched patients of RHD without CAD (Group B). Result: The overall prevalence of CAD in the patients undergoing valvular intervention was 9.1% (66.7% males, 33.3% female; mean age 55.20±8.6). The CAD incidence in patients with mitral, aortic and both valve replacement were 24.1%, 10.8% and 6.1% respectively. The prevalence of smoking habit (33.3% vs. 20.9%), diabetes (24.6% vs. 3.1%), hypertension (21.7% vs. 6.8%), postmenopausal status (65.2% vs. 18.4%), family history of CAD (17.4% vs. 8.3%) and aortic valve disease (10.1%) was significantly higher in group A as compared to group B except for obesity (11.5% vs. 18.7%). Conclusion: Prevalence of CAD in patients with valvular heart disease in western population of Asian Indians is 9.1%. Coronary angiography should be performed in patients having CAD risk factors, irrespective of the valvular lesion involved.
Frontiers in Cardiovascular Medicine, Jan 24, 2023
According to World Health Organization (WHO), cardiovascular diseases (CVD) remains the number on... more According to World Health Organization (WHO), cardiovascular diseases (CVD) remains the number one killer in developing as well as developed countries, accounting for 17.9 million deaths each year (32% of the total deaths), with an expected increase to 23.6 million by 2030 . With the chronic nature of the condition, CVD not only has long-term clinical consequences but also a substantial economic burden on both health systems and patients. The CVD cost globally was approximately US$ 863 billion in 2010 and is estimated to rise by 22% (around US$ 1,044 billion) by 2030 (1). Cost estimate for coronary heart disease (CHD) and stroke can be as high as 5,000 US$ per episode (2). Moreover, an epidemiological shift with the disease affecting the younger population at large has made the situation more alarming. These have paved the way for investing in inventing, designing, and implementing approaches and healthcare technologies (HCTs) for improving diagnosis, treatment, and prognosis of CVD with substantial efforts being directed toward the assessment of these technological support solutions. Over the last few decades, the advancement in medical technologies has touched almost all spheres of life with health care innovations aiding clinicians and health care professionals (HCP) in decision making. HCTs have become one of the fastest growing global markets with an estimated size of 857.58 US$ billion by 2030 . Unfortunately, adopting these new technologies can put a huge financial burden on the healthcare system. Hence, it is imperative to identify and adopt technologies and interventions which can contribute significantly to the prevention and management of the disease and provide economically, socially, and contextually acceptable alternatives through systematic, ethical, unbiased, transparent, and robust methods of innovation. These evidence-supported approaches can guide policy decisions for both developing and developed economies. The goal is to support the interventions for a sustainable health system. Health Technology Assessment (HTA) is a relatively new concept in developing countries. It is defined as a form of policy research that supports an evidence-based decision for the use of any technological innovation aiming to improve health outcomes. It recommends the incorporation of innovation in the policy on the bases of clinical efficacy, economic effectiveness, Frontiers in Cardiovascular Medicine frontiersin.org
Background and objectivesAlthough a relatively recent concept for developing countries, the devel... more Background and objectivesAlthough a relatively recent concept for developing countries, the developed world has been using League Tables as a policy guiding tool for a comprehensive assessment of health expenditures; country-specific “League tables” can be a very useful tool for national healthcare planning and budgeting. Presented herewith is a comprehensive league table of cost per Quality Adjusted Life Years (QALY) or Disability Adjusted Life Years (DALY) ratios derived from Health Technology Assessment (HTA) or economic evaluation studies reported from India through a systematic review.MethodsEconomic evaluations and HTAs published from January 2003 to October 2019 were searched from various databases. We only included the studies reporting common outcomes (QALY/DALY) and methodology to increase the generalizability of league table findings. To opt for a uniform criterion, a reference case approach developed by Health Technology Assessment in India (HTAIn) was used for the repor...
The world has witnessed the dreadful COVID-19 pandemic and the rapid rate of its spread across co... more The world has witnessed the dreadful COVID-19 pandemic and the rapid rate of its spread across countries. The key measures in pandemic control includes early detection of cases, isolation of cases to prevent spread and appropriate management of confirmed cases. The present diagnostic criteria for COVID-19 in India is based on RT-PCR. This technique has its own limitations. There are ongoing debates to the cost, time taken and type of diagnostic sensitivity and predictive values of RT-PCR. Researchers across globe have been exploring alternative methods to enhance the mainstay of protocols for identifying suspected cases of COVID-19. With media news of too many asymptomatic positive results from community in New Delhi, Ahmedabad and other places in India, along with prompt withdrawal of antibody based tests by ICMR after questions on validity, such test raises concerns and urgent need for exploring the need for rethinking the diagnostic algorithm. This is a systematic review to explo...
Anemia is an important public health concern, affecting almost 25% of the global population. In I... more Anemia is an important public health concern, affecting almost 25% of the global population. In India, these statistics are even more worrisome with more than half of the children, non-pregnant and pregnant women being affected by the disease. Though the major cause of anemia is iron deficiency, other causes cannot be neglected considering the magnitude of the problem. The present study was designed to estimate the prevalence of non-iron deficiency anemia (NIDA) in Devbhoomi Dwarka District of Gujarat. For this cross-sectional study, total of 258 mothers (antenatal and postnatal) were enrolled from 27 primary health centers. Apart from demographic details and obstetric history, hemoglobin and ferritin levels were measured from the participant's blood after obtaining consent. Clinical information such as the history of recent illness and fever were also noted through questionnaires. Prevalence was anemia was calculated using a standard threshold of blood hemoglobin and NIDM was defined using ferritin levels. As per hemoglobin levels, anemia was present in 65.9% of the mothers, which was relatively higher in antenatal women (90%) as compared to postnatal women (57%). Ferritin levels showed that out of this total anemic mothers, 61.8% (105/258) have normal ferritin levels indicating the presence of non-iron deficiency. Trimester-wise analysis of anemia in AN showed that NIDM prevalence increases with increasing trimester in contrast to IDA where a considerable reduction was found with iron supplementation. The study indicated that two out of every three women were anemic and only one out of four were anemic with depleted iron storage. These findings have important policy implications as in India the anemia control programs address only iron deficiency anemia and not NIDA. The development of a framework for diagnosis and appropriate treatment can be recommended for integration into national guidelines.
ObjectiveHealth Technology Assessment (HTA) is a comprehensive and important tool for assessment ... more ObjectiveHealth Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal.Materials and methodsWe searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016–2021) in a systematic way with a controlled vocabulary using a...
Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. ... more Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. We aim to study secondary attack rate (SAR) of COVID-19 in household contacts of pediatric index cases from Gujarat, Western Indian state. Methods For this cross-sectional study, details of 2412 paediatric patients were collected from Government records. Through stratified random sampling 10% (n = 242) of the patients were selected for the study and were telephonically contacted for obtaining the details of household secondary infection; 72 pediatric index cases having 287 household contacts were included in the study. Results The SAR in household contacts of pediatric index cases was 1.7% (95% CI: 0.74–4%). Majority of the index cases were males (94.4%) with 66% of the patients being admitted at various hospitals and isolation facilities (45%); 37% were home quarantine. Of 72, 50 (74%) cases were aged between 12 and 18 years. The family size of the index cases causing secondary infectio...
Background: There is a surge in epidemiological modeling research due to sudden onset of COVID-19... more Background: There is a surge in epidemiological modeling research due to sudden onset of COVID-19 pandemic across the globe. In the absence of any pharmaceutical interventions to control the epidemic, nonpharmaceutical interventions like containment, mitigation and suppression are tried and tested partners in epidemiological theories. But policy and planning needs estimates of disease burden in various scenarios in absence of real data and epidemiological models helps to fill this gap. Aims and Objectives: To review the models of COVID-19 prediction in Indian scenario, critically evaluate the range, concepts, strength and limitations of these prediction models and its potential policy implications. Results: Though we conducted data search for last three months, it was found that the predictive models reporting from Indian context have started publishing very recently. Majority of the Indian models predicted COVID-19 spread, projected best-, worst case scenario and forecasted effect ...
International Journal of Medical Research and Review, 2016
Introduction: Coronary artery anomalies (CAA) are diverse abnormalities. Methods: A retrospective... more Introduction: Coronary artery anomalies (CAA) are diverse abnormalities. Methods: A retrospective review of coronary imaging of 17,245 patients over 2 years was performed. Patients with CAA detected on echocardiography, invasive coronary angiography (CAG) and multidetector computed tomographic angiography (MDCTA) were compared. Results: CAAs were detected in 257 patients (1.49%). Prevalence were: absent left main trunk-0.319%, anomalous coronary artery from opposite sinus (ACAOS)-0.516%, coronary fistulae-0.203%, myocardial bridge-0.093%, malignant anomalies-0.3%. The commonest CAA was absent left main trunk. The yield of echocardiography negatively correlated with age (r=-0.6). CAG and MDCTA were equal (p=1) for detection of absent left main trunk. CAG had low sensitivity (58.3%) and MDCTA was better than it (p<0.01) for detection of abnormal high origin. For ACAOS, detection by both were not different (p=0.5) but the course was delineated better with MDCTA than with CAG (p=0.05). Both were equal for detection of intramyocardial course (p=0.5). However, MDCTA delineated its course better than CAG (p<0.01). Echocardiography had 93% sensitivity for fistula in those <12 years in age. Radiation exposure with CAG, 7.3 ± 2mSv, was lower than that with MDCTA, 14.5 ± 3mSv (p<0.01). It correlated with CAA score (r=0.3), with CAG but not with MDCTA. Contrast exposure correlated with CAA score (r=0.4) for adults with CAG but not with MDCTA. Conclusion: Echocardiography reliably detects CAAs in children. CAG and MDCTA are comparable for detection of most CAA. MDCTA delineates the course better than CAG. For MDCTA, radiation exposure is not correlated with complexity of CAA in contrast to that with CAG.
Internet Journal of Medical Update - EJOURNAL, 2016
The aim of the present study was to determine the diagnostic accuracy of non-invasive tests in pa... more The aim of the present study was to determine the diagnostic accuracy of non-invasive tests in patients with Tetralogy of Fallot prior to biventricular repair, and the need of invasive angiocardiography in specific subgroups. A retrospective analysis was performed for paediatric patients with Tetralogy of Fallot who underwent biventricular repair in three consecutive months. Patients were divided into two groups according to their age: below and above 5 years. We compared the findings of different imaging modalities (e.g. echocardiography, multi-detector Computed Tomography (CT) and invasive angiocardiography) to intraoperative findings to determine their accuracies in different subgroups. Results showed that echocardiography is reliable for preoperative imaging, especially in younger children (sensitivity=71.43%) and its findings are 'moderately' concordant with intraoperative findings (kappa=0.439). For patients above 5 years of age, its sensitivity (29.41%) declines and findings are 'poorly' concordant with intraoperative findings (kappa=0.093). With addition of multi-detector CT, the findings of non-invasive means are 'perfectly' concordant with the intraoperative findings (kappa=1) in children below 5 years and 'moderately' concordant with those (kappa=0.4) in children above 5 years. The findings of CT are 'moderately' concordant with those of invasive angiocardiography (kappa=0.4). Tetralogy of Fallot patients below 5 years can directly be subjected to surgery with work-up including detailed echocardiography only. If anatomy is not clearly delineated, CT helps and invasive angiocardiography is not essential. In patients above 5 years, CT has an important role in defining anatomy. The need for catheterization is limited to hemodynamic evaluation of prior shunt and embolization of aorto-pulmonary collaterals.
QJM: An International Journal of Medicine, Jul 16, 2018
Background/Introduction: Nutritional studies have indicated a critical role of dietary habits in ... more Background/Introduction: Nutritional studies have indicated a critical role of dietary habits in development of cardiovascular diseases (CVD). Aim: We aimed to compare the risk of coronary artery disease (CAD) in habitual 'breakfast skippers' with those of 'habitual breakfast eaters' in Western part of India. We also planned to compare the cardiometabolic profiles of both the groups. Design: In this prospective, case-control study of 1607 individuals; 980 were patients of CAD (cases) undergoing various cardiac interventions for revascularisation and other 627 were healthy individuals (controls) who were free from CAD. Methods: Details of demographics and classical risk factors were collected for all the participants. Subjects were categorized as 'breakfast eater' or 'breakfast skippers' according to their response to the questionnaire. Logistic regression and correlation analysis were performed to assess the independent risk of all the factors and their inter-variable association. Results: Significantly (P < 0.05) high prevalence of classical risk factors and breakfast skipping habit was found in cases when compared with controls. Diabetes showed the highest odds ratio (7.296; 95% confidence interval (CI) 4.825-11.030; P < 0.0001) for CAD, followed by hypertension (3.756; 95% CI 2.891-4.881; P < 0.0001) and habits of smoking/tobacco/alcohol consumption (1.914; 95% CI 1.528-2.398; P < 0.0001) and breakfast skipping 1.348 (95% CI 1.076-1.689; P < 0.0001). Breakfast skipping emerged as stronger risk factor than obesity and sedentary life style in Indians and showed close association with presence of hypertension. Discussion/Conclusion: Habitual breakfast skippers are at increased risk for development of CAD and hypertension in Western India.
Introduction We herewith aimed to explore the association of premature graying, androgenic alopec... more Introduction We herewith aimed to explore the association of premature graying, androgenic alopecia (AGA), and hair thinning with coronary artery disease (CAD) in young (≤ 40 years) male individuals from Western India. Patients and methods In this prospective, case-control study, 1380 male individuals from a super speciality cardiac care center were enrolled, of which 468 were established cases of CAD and 912 were age-matched healthy male individuals not having history of any major illness including CAD. Details of demographics, cardiovascular risk factors, and cutaneous markers were collected for both the groups. Results Prevalence of hypertension (30.3 vs. 13.6%), obesity (28.8 vs. 12.2%), hair thinning (36.3 vs. 14.6%), premature graying (49.6 vs. 29.9%), AGA (49.1 vs. 27.4%), and lipid abnormalities (total cholesterol-16.7 vs. 8.8%; low-density lipoprotein-7.3 vs. 2.2%; and high-density lipoprotein-92.5 vs. 88.7%) were higher in cases as compared with control. Multiple logistic regression analysis showed that AGA [5.619, 95% confidence interval (CI): 4.025-7.845, P < 0.0001] is the strongest predictor of CAD among young Asian male individuals, closely followed by premature graying (5.267, 95% CI: 3.716-7.466, P < 0.0001), obesity (4.133, 95% CI: 2.839-6.018, P < 0.0001), and hair thinning (3.36, 95% CI: 2.452-4.621, P < 0.0001). SYNTAX score, left ventricle ejection fraction, and degree of disease severity were also found to be independent associates of premature graying and AGA. Conclusion Our findings support the hypothesis that cutaneous markers are independently associated with underlying CAD irrespective of other classical cardiovascular risk factors. This, in combination with classical markers, could be effectively used for early identification and risk stratification of young patients with occult or established CAD.
Summary Background The evidence regarding the efficacy of vitamin D supplementation in reducing s... more Summary Background The evidence regarding the efficacy of vitamin D supplementation in reducing severity of COVID-19 is still insufficient. This is partially due to the lack of primary robust trial-based data and heterogeneous study designs. Aim This evidence summary, aims to study the effect of vitamin D supplementation on morbidity and mortality in hospitalized COVID-19 patients. Design: Evidence summary of systematic reviews Methods For this study, systematic reviews and meta-analysis published from December 2019 to January 2022 presenting the impact of vitamin D supplementation on COVID-19 severity were screened and selected from PubMed and Google scholar. After initial screening, 10 eligible reviews were identified and quality of included reviews were assessed using AMSTAR and GRADE tools and overlapping among the primary studies used were also assessed. Results The number of primary studies included in the systematic reviews ranged from 3 to 13. Meta-analysis of seven systemat...
Introduction:Themetabolic syndrome (MetS) is an epidemiological construct of different permutatio... more Introduction:Themetabolic syndrome (MetS) is an epidemiological construct of different permutations of risk factors. We aimed to compare and study the overall prevalence of MetS in healthy, asymptomatic young v/s old Gujarati population. Methods:This population based -cross sectional study involved a total of 3329 healthy adults of 18 -70 years of age. Clinical data such as body mass index (BMI), waist circumference (WC), blood pressure (BP) were measured along with the biochemical estimations of lipids and fasting blood g lucose (FBS). The overall population was categorized in young (<40 years) and old ( "e40 years) individuals. Results:The overall prevalence of MetS was 34.3% where the incidence was found to be more than double in old(45.4%) as compared to young population (20.8%, p<0.0001). The level of FBS (99.82 ± 38.49 vs 87.65 ± 19.82), HDL -C (38.94 ± 7.35 vs 37 ± 6.42) and LDL
Healthline, Journal of Indian Association of Preventive and Social Medicine, 2015
species, resistance to antifungals and clinical profile along with associated risk factors were a... more species, resistance to antifungals and clinical profile along with associated risk factors were analyzed. Overall 45 patients with positive blood culture and 116 patients with positive urine culture were included in the study. Total 32 cases of candidiasis were identified over the study period which includes 4 cases of candidemia and 28 cases of candiduria. The most common co-morbidities were prolonged ICU stay [for more than 4 days (100%)], multiple antibiotics [more than two (100%)], urinary catheterization (100%), diabetes (25%), mechanical ventilator support (31.25%) and central venous catheterization (9.3%). the most common species identified in blood and in urine. The rates of susceptibility to antifungal agents were found as Amphotericin B (100%), Voriconazole (97%), Fluconazole (81%), Itraconazole (75%) and Miconazole (47%). Prevalence of candidiasis in ICU is significantly high than general wards (p<0.0001). Most patients had one or more co-morbidities at the time of the...
Introduction: Framingham 10 years risk estimation tools are potentially a cost-effective strategy... more Introduction: Framingham 10 years risk estimation tools are potentially a cost-effective strategy for cardiovascular disease (CVD) prevention in developing countries. The current investigation was designed to predict CVD risk in healthy and asymptomatic Gujarati Asian Indians. Methods: It was observational study of 2483 individuals of Gujarat state having no past or present history of major illness including CVD. The study cohort was stratified into three groups of low-, intermediate-and high risk of CVD according to the Framingham 10 years risk calculator and the contributing factors for higher CVD risk were studied. Results : Out of 2483 individuals, (65.4%) had low risk of CVD event followed by 21.95% having intermediate and 12.65% showing high risk. The low level of HDL-C (85.03%), hypertension (63.69%) and elevated TC (60.83%) and LDL-C (60.83%) were found to be the main contributors for CVD risk. In high risk males the levels of TC (58.45%) and LDL-C (58.1%) were significantly elevated (p<0.0001), whereas levels of HDL-C (92.25%) markedly low in this subset of population, whereas in females hypertension (100%) and abnormalities of lipids (TC-83.33%, LDL-C-86.67%) were the contributors. The CVD risk increased with age in both the genders where maximum risk was found at the population being in the 60-69 years (male-45.07%; female-46.67%) of the age. Conclusion: Higher risk in Gujarati Asian Indian community is mainly attributed by dyslipidemias and hypertension. Both of them being modifiable risk factors, the life style modification is highly advocated in this ethnic group.
The COVID-19 pandemic has posed signi cant concern revolves around the prolonged effects experien... more The COVID-19 pandemic has posed signi cant concern revolves around the prolonged effects experienced by a subset of individuals post-acute sequelae of SARS-COV-2 infection, termed long COVID. This study protocol outlines the methodology for a meta-analysis and systematic review with the objective of comprehensively assessing the prolonged effects of COVID-19 on the Indian population and determine the likely risk factors connected to the development and persistence of long COVID. A comprehensive search strategy will be employed across major databases. By combining data from various studies, the expected outcomes include a clearer understanding and documentation of long-term prevalence rates of COVID, symptom pro les, regional disparities, and potential determinants for long-term COVID conditions within the Indian population. The anticipated ndings will contribute to a re ned understanding of this condition, guiding healthcare interventions and future research endeavors aimed at mitigating the impact of the long COVID condition on the Indian population.
Evidence-based Complementary and Alternative Medicine, Oct 7, 2022
Introduction. COVID-19, a multisystem disease, has implications for various immunity and infectio... more Introduction. COVID-19, a multisystem disease, has implications for various immunity and infection biomarkers. Yoga (Y), meditation (M), and pranayama (P), and their combinations have shown positive changes on those biomarkers among other than COVID-19 patients and healthy people. So, we aimed to document the evidence of possible implication in a systematic way. Materials and Methods. We screened 84 full texts, published in the last ten years, from three databases, from which only 44 met the eligibility criteria, and then extracted the data related to demographic characteristics, intervention, results, and strengths and limitations in two MS-Excel grids, and then presented them in tables and gures. Furthermore, we carried out meta-analysis including subgroup and sensitivity analysis using a random e ects model of 11 RCTs and reported the mean di erence, heterogeneity, and p value with 95% CI and presented them with forest and funnel plots and the tables. Results. Twenty-ve biomarkers of 4023 participants (range, 15-413) from 13 countries, healthy and clinical, from both sexes above 18 years, and from mainly clinical settings, were reported. YMP intervention, in solitary or in di erent possible combinations with varied durations among clinical and pregnant (range, 960-4800 minutes) and healthy (960-8400 minutes, excluding two studies of 20 minutes only) participants, was reported. It was revealed that 25 biomarkers, nine among the apparently healthy, 14 among the patients, and two among the pregnant, changed favourably (p < 0.05). Furthermore, either in meta-or subgroup-analysis, mean di erences of IL-6 (-1.44 pg/ml) (95% CI) (-2.33, -0.55), (p 0.002, I 2 = 82%), Cortisol (-40.75 pg/ml) (95% CI) (-64.13, -17.38), (p 0.0006, I 2 = 87%), and TNF-α (-3.40 pg/ml) (95% CI) (-4.83, -1.98), (p < 0.0001, I 2 = 79%) showed statistically signi cant changes. Nonetheless, considerable heterogeneity and publication bias were observed among the studies. Conclusion. Although more than two dozens of biomarkers in individual studies showed favourable changes, only IL-6, Cortisol, and TNF-α produced signi cant combined results, even then with much less certainty. Further meta-analysis of biomarkers of COVID-19 patients is highly recommended. Registration: CRD42021283894.
QJM: An International Journal of Medicine, Jul 29, 2020
Coronavirus disease 2019 (COVID-19) is a novel virus with continuously evolving transmission tren... more Coronavirus disease 2019 (COVID-19) is a novel virus with continuously evolving transmission trends. Contact tracing and quarantining of positive cases are chief strategies of disease control that has been accepted globally, though scientific knowledge regarding household transmission of the COVID-19 through contact of positive case is sparse. Current systematic review was planned to assess global statistics and characteristics of household secondary attack rate (SAR) of COVID-19. Eligible articles were retrieved through search of-MEDLINE, SCOPUS and EMBASE for the period December 2019 to 15 June 2020. Search terms were developed to identify articles reporting household SARs in various countries. After initial screening of 326 articles, 13 eligible studies were included in the final evidence synthesis. We found that SAR varies widely across countries with lowest reported rate as 4.6% and highest as 49.56%. The rates were unaffected by confounders such as population of the country, lockdown status and geographic location. Review suggested greater vulnerability of spouse and elderly population for secondary transmission than other household members. It was also observed that quarantining and isolation are most effective strategies for prevention of the secondary transmission of the disease. Symptomatic status of the index case emerged to be a critical factor, with very low transmission probability during asymptomatic phase. Present review findings recommend that adequate measures should be provided to protect the vulnerable population as only case tracing and quarantining might be insufficient. It should be combined with advisory for limiting household contacts and active surveillance for symptom onset.
Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. ... more Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. We aim to study secondary attack rate (SAR) of COVID-19 in household contacts of pediatric index cases from Gujarat, Western Indian state. Methods For this cross-sectional study, details of 2412 paediatric patients were collected from Government records. Through stratified random sampling 10% (n = 242) of the patients were selected for the study and were telephonically contacted for obtaining the details of household secondary infection; 72 pediatric index cases having 287 household contacts were included in the study. The SAR in household contacts of pediatric index cases was 1.7% (95% CI: 0.74-4%). Majority of the index cases were males (94.4%) with 66% of the patients being admitted at various hospitals and isolation facilities (45%); 37% were home quarantine. Of 72, 50 (74%) cases were aged between 12 and 18 years. The family size of the index cases causing secondary infection was comparatively larger than index cases without secondary household infection (6.75 ± 2.3 versus 4.9 ± 1.9; P = 0.034). The household SAR from pediatric patients is low and is closely associated with the family size of the index cases. Hence, home quarantine should be advocated in smaller families with appropriate isolation facilities.
International journal of medical research and review, Oct 31, 2016
We aimed to determine the overall prevalence of coronary artery disease (CAD), atherosclerotic ri... more We aimed to determine the overall prevalence of coronary artery disease (CAD), atherosclerotic risk factors and clinical profile of patients with rheumatic heart disease (RHD) undergoing valvular interventions in Asian Indians. Method: This was an all comers, observational, prospective study of 757 rheumatic patients, who underwent coronary angiography (CAG) prior to percutaneous balloon valvulotomy, surgical valvular repair or replacement from July 2011 to December 2013. Among them who had significant CAD (stenosis ≥50%) (Group A), were compared with similar number of age and sex matched patients of RHD without CAD (Group B). Result: The overall prevalence of CAD in the patients undergoing valvular intervention was 9.1% (66.7% males, 33.3% female; mean age 55.20±8.6). The CAD incidence in patients with mitral, aortic and both valve replacement were 24.1%, 10.8% and 6.1% respectively. The prevalence of smoking habit (33.3% vs. 20.9%), diabetes (24.6% vs. 3.1%), hypertension (21.7% vs. 6.8%), postmenopausal status (65.2% vs. 18.4%), family history of CAD (17.4% vs. 8.3%) and aortic valve disease (10.1%) was significantly higher in group A as compared to group B except for obesity (11.5% vs. 18.7%). Conclusion: Prevalence of CAD in patients with valvular heart disease in western population of Asian Indians is 9.1%. Coronary angiography should be performed in patients having CAD risk factors, irrespective of the valvular lesion involved.
Frontiers in Cardiovascular Medicine, Jan 24, 2023
According to World Health Organization (WHO), cardiovascular diseases (CVD) remains the number on... more According to World Health Organization (WHO), cardiovascular diseases (CVD) remains the number one killer in developing as well as developed countries, accounting for 17.9 million deaths each year (32% of the total deaths), with an expected increase to 23.6 million by 2030 . With the chronic nature of the condition, CVD not only has long-term clinical consequences but also a substantial economic burden on both health systems and patients. The CVD cost globally was approximately US$ 863 billion in 2010 and is estimated to rise by 22% (around US$ 1,044 billion) by 2030 (1). Cost estimate for coronary heart disease (CHD) and stroke can be as high as 5,000 US$ per episode (2). Moreover, an epidemiological shift with the disease affecting the younger population at large has made the situation more alarming. These have paved the way for investing in inventing, designing, and implementing approaches and healthcare technologies (HCTs) for improving diagnosis, treatment, and prognosis of CVD with substantial efforts being directed toward the assessment of these technological support solutions. Over the last few decades, the advancement in medical technologies has touched almost all spheres of life with health care innovations aiding clinicians and health care professionals (HCP) in decision making. HCTs have become one of the fastest growing global markets with an estimated size of 857.58 US$ billion by 2030 . Unfortunately, adopting these new technologies can put a huge financial burden on the healthcare system. Hence, it is imperative to identify and adopt technologies and interventions which can contribute significantly to the prevention and management of the disease and provide economically, socially, and contextually acceptable alternatives through systematic, ethical, unbiased, transparent, and robust methods of innovation. These evidence-supported approaches can guide policy decisions for both developing and developed economies. The goal is to support the interventions for a sustainable health system. Health Technology Assessment (HTA) is a relatively new concept in developing countries. It is defined as a form of policy research that supports an evidence-based decision for the use of any technological innovation aiming to improve health outcomes. It recommends the incorporation of innovation in the policy on the bases of clinical efficacy, economic effectiveness, Frontiers in Cardiovascular Medicine frontiersin.org
Background and objectivesAlthough a relatively recent concept for developing countries, the devel... more Background and objectivesAlthough a relatively recent concept for developing countries, the developed world has been using League Tables as a policy guiding tool for a comprehensive assessment of health expenditures; country-specific “League tables” can be a very useful tool for national healthcare planning and budgeting. Presented herewith is a comprehensive league table of cost per Quality Adjusted Life Years (QALY) or Disability Adjusted Life Years (DALY) ratios derived from Health Technology Assessment (HTA) or economic evaluation studies reported from India through a systematic review.MethodsEconomic evaluations and HTAs published from January 2003 to October 2019 were searched from various databases. We only included the studies reporting common outcomes (QALY/DALY) and methodology to increase the generalizability of league table findings. To opt for a uniform criterion, a reference case approach developed by Health Technology Assessment in India (HTAIn) was used for the repor...
The world has witnessed the dreadful COVID-19 pandemic and the rapid rate of its spread across co... more The world has witnessed the dreadful COVID-19 pandemic and the rapid rate of its spread across countries. The key measures in pandemic control includes early detection of cases, isolation of cases to prevent spread and appropriate management of confirmed cases. The present diagnostic criteria for COVID-19 in India is based on RT-PCR. This technique has its own limitations. There are ongoing debates to the cost, time taken and type of diagnostic sensitivity and predictive values of RT-PCR. Researchers across globe have been exploring alternative methods to enhance the mainstay of protocols for identifying suspected cases of COVID-19. With media news of too many asymptomatic positive results from community in New Delhi, Ahmedabad and other places in India, along with prompt withdrawal of antibody based tests by ICMR after questions on validity, such test raises concerns and urgent need for exploring the need for rethinking the diagnostic algorithm. This is a systematic review to explo...
Anemia is an important public health concern, affecting almost 25% of the global population. In I... more Anemia is an important public health concern, affecting almost 25% of the global population. In India, these statistics are even more worrisome with more than half of the children, non-pregnant and pregnant women being affected by the disease. Though the major cause of anemia is iron deficiency, other causes cannot be neglected considering the magnitude of the problem. The present study was designed to estimate the prevalence of non-iron deficiency anemia (NIDA) in Devbhoomi Dwarka District of Gujarat. For this cross-sectional study, total of 258 mothers (antenatal and postnatal) were enrolled from 27 primary health centers. Apart from demographic details and obstetric history, hemoglobin and ferritin levels were measured from the participant's blood after obtaining consent. Clinical information such as the history of recent illness and fever were also noted through questionnaires. Prevalence was anemia was calculated using a standard threshold of blood hemoglobin and NIDM was defined using ferritin levels. As per hemoglobin levels, anemia was present in 65.9% of the mothers, which was relatively higher in antenatal women (90%) as compared to postnatal women (57%). Ferritin levels showed that out of this total anemic mothers, 61.8% (105/258) have normal ferritin levels indicating the presence of non-iron deficiency. Trimester-wise analysis of anemia in AN showed that NIDM prevalence increases with increasing trimester in contrast to IDA where a considerable reduction was found with iron supplementation. The study indicated that two out of every three women were anemic and only one out of four were anemic with depleted iron storage. These findings have important policy implications as in India the anemia control programs address only iron deficiency anemia and not NIDA. The development of a framework for diagnosis and appropriate treatment can be recommended for integration into national guidelines.
ObjectiveHealth Technology Assessment (HTA) is a comprehensive and important tool for assessment ... more ObjectiveHealth Technology Assessment (HTA) is a comprehensive and important tool for assessment and decision-making in public health and healthcare practice. It is recommended by the WHO and has been applied in practice in many countries, mostly the developed ones. HTA might be an important tool to achieve universal health coverage (UHC), especially beneficial to low-and-middle-income countries (LMIC). Even though the Package for Essential Non-communicable Diseases (PEN) has already been initiated, there is a clear policy gap in the HTA of any health device, service, or procedure, including the assessment of cardiovascular risk factors (CVRFs) in Nepal. Hence, we carried out the review to document the HTA supported evidence of hypertension and diabetes screening, as CVRFs in Nepal.Materials and methodsWe searched in PubMed, Cochrane, and Google Scholar, along with some gray literature published in the last 6 years (2016–2021) in a systematic way with a controlled vocabulary using a...
Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. ... more Background Role of pediatric cases in secondary transmission of COVID-19 is not well understood. We aim to study secondary attack rate (SAR) of COVID-19 in household contacts of pediatric index cases from Gujarat, Western Indian state. Methods For this cross-sectional study, details of 2412 paediatric patients were collected from Government records. Through stratified random sampling 10% (n = 242) of the patients were selected for the study and were telephonically contacted for obtaining the details of household secondary infection; 72 pediatric index cases having 287 household contacts were included in the study. Results The SAR in household contacts of pediatric index cases was 1.7% (95% CI: 0.74–4%). Majority of the index cases were males (94.4%) with 66% of the patients being admitted at various hospitals and isolation facilities (45%); 37% were home quarantine. Of 72, 50 (74%) cases were aged between 12 and 18 years. The family size of the index cases causing secondary infectio...
Background: There is a surge in epidemiological modeling research due to sudden onset of COVID-19... more Background: There is a surge in epidemiological modeling research due to sudden onset of COVID-19 pandemic across the globe. In the absence of any pharmaceutical interventions to control the epidemic, nonpharmaceutical interventions like containment, mitigation and suppression are tried and tested partners in epidemiological theories. But policy and planning needs estimates of disease burden in various scenarios in absence of real data and epidemiological models helps to fill this gap. Aims and Objectives: To review the models of COVID-19 prediction in Indian scenario, critically evaluate the range, concepts, strength and limitations of these prediction models and its potential policy implications. Results: Though we conducted data search for last three months, it was found that the predictive models reporting from Indian context have started publishing very recently. Majority of the Indian models predicted COVID-19 spread, projected best-, worst case scenario and forecasted effect ...
International Journal of Medical Research and Review, 2016
Introduction: Coronary artery anomalies (CAA) are diverse abnormalities. Methods: A retrospective... more Introduction: Coronary artery anomalies (CAA) are diverse abnormalities. Methods: A retrospective review of coronary imaging of 17,245 patients over 2 years was performed. Patients with CAA detected on echocardiography, invasive coronary angiography (CAG) and multidetector computed tomographic angiography (MDCTA) were compared. Results: CAAs were detected in 257 patients (1.49%). Prevalence were: absent left main trunk-0.319%, anomalous coronary artery from opposite sinus (ACAOS)-0.516%, coronary fistulae-0.203%, myocardial bridge-0.093%, malignant anomalies-0.3%. The commonest CAA was absent left main trunk. The yield of echocardiography negatively correlated with age (r=-0.6). CAG and MDCTA were equal (p=1) for detection of absent left main trunk. CAG had low sensitivity (58.3%) and MDCTA was better than it (p<0.01) for detection of abnormal high origin. For ACAOS, detection by both were not different (p=0.5) but the course was delineated better with MDCTA than with CAG (p=0.05). Both were equal for detection of intramyocardial course (p=0.5). However, MDCTA delineated its course better than CAG (p<0.01). Echocardiography had 93% sensitivity for fistula in those <12 years in age. Radiation exposure with CAG, 7.3 ± 2mSv, was lower than that with MDCTA, 14.5 ± 3mSv (p<0.01). It correlated with CAA score (r=0.3), with CAG but not with MDCTA. Contrast exposure correlated with CAA score (r=0.4) for adults with CAG but not with MDCTA. Conclusion: Echocardiography reliably detects CAAs in children. CAG and MDCTA are comparable for detection of most CAA. MDCTA delineates the course better than CAG. For MDCTA, radiation exposure is not correlated with complexity of CAA in contrast to that with CAG.
Internet Journal of Medical Update - EJOURNAL, 2016
The aim of the present study was to determine the diagnostic accuracy of non-invasive tests in pa... more The aim of the present study was to determine the diagnostic accuracy of non-invasive tests in patients with Tetralogy of Fallot prior to biventricular repair, and the need of invasive angiocardiography in specific subgroups. A retrospective analysis was performed for paediatric patients with Tetralogy of Fallot who underwent biventricular repair in three consecutive months. Patients were divided into two groups according to their age: below and above 5 years. We compared the findings of different imaging modalities (e.g. echocardiography, multi-detector Computed Tomography (CT) and invasive angiocardiography) to intraoperative findings to determine their accuracies in different subgroups. Results showed that echocardiography is reliable for preoperative imaging, especially in younger children (sensitivity=71.43%) and its findings are 'moderately' concordant with intraoperative findings (kappa=0.439). For patients above 5 years of age, its sensitivity (29.41%) declines and findings are 'poorly' concordant with intraoperative findings (kappa=0.093). With addition of multi-detector CT, the findings of non-invasive means are 'perfectly' concordant with the intraoperative findings (kappa=1) in children below 5 years and 'moderately' concordant with those (kappa=0.4) in children above 5 years. The findings of CT are 'moderately' concordant with those of invasive angiocardiography (kappa=0.4). Tetralogy of Fallot patients below 5 years can directly be subjected to surgery with work-up including detailed echocardiography only. If anatomy is not clearly delineated, CT helps and invasive angiocardiography is not essential. In patients above 5 years, CT has an important role in defining anatomy. The need for catheterization is limited to hemodynamic evaluation of prior shunt and embolization of aorto-pulmonary collaterals.
QJM: An International Journal of Medicine, Jul 16, 2018
Background/Introduction: Nutritional studies have indicated a critical role of dietary habits in ... more Background/Introduction: Nutritional studies have indicated a critical role of dietary habits in development of cardiovascular diseases (CVD). Aim: We aimed to compare the risk of coronary artery disease (CAD) in habitual 'breakfast skippers' with those of 'habitual breakfast eaters' in Western part of India. We also planned to compare the cardiometabolic profiles of both the groups. Design: In this prospective, case-control study of 1607 individuals; 980 were patients of CAD (cases) undergoing various cardiac interventions for revascularisation and other 627 were healthy individuals (controls) who were free from CAD. Methods: Details of demographics and classical risk factors were collected for all the participants. Subjects were categorized as 'breakfast eater' or 'breakfast skippers' according to their response to the questionnaire. Logistic regression and correlation analysis were performed to assess the independent risk of all the factors and their inter-variable association. Results: Significantly (P < 0.05) high prevalence of classical risk factors and breakfast skipping habit was found in cases when compared with controls. Diabetes showed the highest odds ratio (7.296; 95% confidence interval (CI) 4.825-11.030; P < 0.0001) for CAD, followed by hypertension (3.756; 95% CI 2.891-4.881; P < 0.0001) and habits of smoking/tobacco/alcohol consumption (1.914; 95% CI 1.528-2.398; P < 0.0001) and breakfast skipping 1.348 (95% CI 1.076-1.689; P < 0.0001). Breakfast skipping emerged as stronger risk factor than obesity and sedentary life style in Indians and showed close association with presence of hypertension. Discussion/Conclusion: Habitual breakfast skippers are at increased risk for development of CAD and hypertension in Western India.
Introduction We herewith aimed to explore the association of premature graying, androgenic alopec... more Introduction We herewith aimed to explore the association of premature graying, androgenic alopecia (AGA), and hair thinning with coronary artery disease (CAD) in young (≤ 40 years) male individuals from Western India. Patients and methods In this prospective, case-control study, 1380 male individuals from a super speciality cardiac care center were enrolled, of which 468 were established cases of CAD and 912 were age-matched healthy male individuals not having history of any major illness including CAD. Details of demographics, cardiovascular risk factors, and cutaneous markers were collected for both the groups. Results Prevalence of hypertension (30.3 vs. 13.6%), obesity (28.8 vs. 12.2%), hair thinning (36.3 vs. 14.6%), premature graying (49.6 vs. 29.9%), AGA (49.1 vs. 27.4%), and lipid abnormalities (total cholesterol-16.7 vs. 8.8%; low-density lipoprotein-7.3 vs. 2.2%; and high-density lipoprotein-92.5 vs. 88.7%) were higher in cases as compared with control. Multiple logistic regression analysis showed that AGA [5.619, 95% confidence interval (CI): 4.025-7.845, P < 0.0001] is the strongest predictor of CAD among young Asian male individuals, closely followed by premature graying (5.267, 95% CI: 3.716-7.466, P < 0.0001), obesity (4.133, 95% CI: 2.839-6.018, P < 0.0001), and hair thinning (3.36, 95% CI: 2.452-4.621, P < 0.0001). SYNTAX score, left ventricle ejection fraction, and degree of disease severity were also found to be independent associates of premature graying and AGA. Conclusion Our findings support the hypothesis that cutaneous markers are independently associated with underlying CAD irrespective of other classical cardiovascular risk factors. This, in combination with classical markers, could be effectively used for early identification and risk stratification of young patients with occult or established CAD.
Summary Background The evidence regarding the efficacy of vitamin D supplementation in reducing s... more Summary Background The evidence regarding the efficacy of vitamin D supplementation in reducing severity of COVID-19 is still insufficient. This is partially due to the lack of primary robust trial-based data and heterogeneous study designs. Aim This evidence summary, aims to study the effect of vitamin D supplementation on morbidity and mortality in hospitalized COVID-19 patients. Design: Evidence summary of systematic reviews Methods For this study, systematic reviews and meta-analysis published from December 2019 to January 2022 presenting the impact of vitamin D supplementation on COVID-19 severity were screened and selected from PubMed and Google scholar. After initial screening, 10 eligible reviews were identified and quality of included reviews were assessed using AMSTAR and GRADE tools and overlapping among the primary studies used were also assessed. Results The number of primary studies included in the systematic reviews ranged from 3 to 13. Meta-analysis of seven systemat...
Introduction:Themetabolic syndrome (MetS) is an epidemiological construct of different permutatio... more Introduction:Themetabolic syndrome (MetS) is an epidemiological construct of different permutations of risk factors. We aimed to compare and study the overall prevalence of MetS in healthy, asymptomatic young v/s old Gujarati population. Methods:This population based -cross sectional study involved a total of 3329 healthy adults of 18 -70 years of age. Clinical data such as body mass index (BMI), waist circumference (WC), blood pressure (BP) were measured along with the biochemical estimations of lipids and fasting blood g lucose (FBS). The overall population was categorized in young (<40 years) and old ( "e40 years) individuals. Results:The overall prevalence of MetS was 34.3% where the incidence was found to be more than double in old(45.4%) as compared to young population (20.8%, p<0.0001). The level of FBS (99.82 ± 38.49 vs 87.65 ± 19.82), HDL -C (38.94 ± 7.35 vs 37 ± 6.42) and LDL
Healthline, Journal of Indian Association of Preventive and Social Medicine, 2015
species, resistance to antifungals and clinical profile along with associated risk factors were a... more species, resistance to antifungals and clinical profile along with associated risk factors were analyzed. Overall 45 patients with positive blood culture and 116 patients with positive urine culture were included in the study. Total 32 cases of candidiasis were identified over the study period which includes 4 cases of candidemia and 28 cases of candiduria. The most common co-morbidities were prolonged ICU stay [for more than 4 days (100%)], multiple antibiotics [more than two (100%)], urinary catheterization (100%), diabetes (25%), mechanical ventilator support (31.25%) and central venous catheterization (9.3%). the most common species identified in blood and in urine. The rates of susceptibility to antifungal agents were found as Amphotericin B (100%), Voriconazole (97%), Fluconazole (81%), Itraconazole (75%) and Miconazole (47%). Prevalence of candidiasis in ICU is significantly high than general wards (p<0.0001). Most patients had one or more co-morbidities at the time of the...
Introduction: Framingham 10 years risk estimation tools are potentially a cost-effective strategy... more Introduction: Framingham 10 years risk estimation tools are potentially a cost-effective strategy for cardiovascular disease (CVD) prevention in developing countries. The current investigation was designed to predict CVD risk in healthy and asymptomatic Gujarati Asian Indians. Methods: It was observational study of 2483 individuals of Gujarat state having no past or present history of major illness including CVD. The study cohort was stratified into three groups of low-, intermediate-and high risk of CVD according to the Framingham 10 years risk calculator and the contributing factors for higher CVD risk were studied. Results : Out of 2483 individuals, (65.4%) had low risk of CVD event followed by 21.95% having intermediate and 12.65% showing high risk. The low level of HDL-C (85.03%), hypertension (63.69%) and elevated TC (60.83%) and LDL-C (60.83%) were found to be the main contributors for CVD risk. In high risk males the levels of TC (58.45%) and LDL-C (58.1%) were significantly elevated (p<0.0001), whereas levels of HDL-C (92.25%) markedly low in this subset of population, whereas in females hypertension (100%) and abnormalities of lipids (TC-83.33%, LDL-C-86.67%) were the contributors. The CVD risk increased with age in both the genders where maximum risk was found at the population being in the 60-69 years (male-45.07%; female-46.67%) of the age. Conclusion: Higher risk in Gujarati Asian Indian community is mainly attributed by dyslipidemias and hypertension. Both of them being modifiable risk factors, the life style modification is highly advocated in this ethnic group.
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