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Byline: Mohamed. Hisham, Mudalipalayam. Sivakumar, Ganesh. Veerasekar Background and Objectives: A critically ill patient is treated and reviewed by physicians from different specialties; hence, polypharmacy is a very common. This [...]

Aims: South Asia has emerged rapidly as an epicentre of non‐communicable diseases (NCDs) specifically diabetes and cardiovascular diseases. The prevalence rate, risk factors and aetiology of NCDs in different socio‐demographic settings are not clearly understood. This study was performed to assess the prevalence of diabetes and atherosclerosis and their risk factors in urban, sub‐urban and rural communities of South India. Methods: Three communities [Nallampatti (rural), Thadagam (sub‐urban) and Kalapatti (urban)] in South India were selected for participation in the KMCH‐NCD Studies. Study volunteers were administered a detailed questionnaire, underwent anthropometric measurements, clinical measurements including blood pressure, glycated haemoglobin (HbA1c), non‐fasting lipid profile and serum creatinine. Carotid intima‐media thickness was measured using B‐mode ultrasound. Multiple logistic regression analyses were performed to understand the association of risk factors with diabetes and atherosclerosis. Results: A total of 2976 native participants, ≥20 years of age were screened. The prevalence of diabetes was 16%, 26% and 23% respectively in the rural, sub‐urban and urban study populations. Association of obesity with diabetes was observed in only urban population while hypertension and dyslipidaemia showed association in both urban and semi‐urban populations. Association of diabetes with atherosclerosis was observed in urban and semi‐urban populations. Hypertension in semi‐urban and obesity and dyslipidaemia in urban population showed association with atherosclerosis. Conclusions: Diabetes and atherosclerosis burden reported in the three different communities were higher than previous reports, especially in rural and sub‐urban regions. No traditional risk factor is identified to be associated with prevalence of diabetes and atherosclerosis in rural population. These findings suggest an urgent need for investigation into the role of non‐traditional risk factors like environmental or occupational exposures may help to better understand the aetiology of diseases in non‐urbanized communities. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to describe the distribution and comparison of carotid intima thickness in two completely different demographics in South India. Materials and Methods: Data were obtained from 865 participants in rural Nallampatti and 1081 participants from urban Kalapatti in the state of Tamil Nadu. Local ethics committee approval and written and informed consent were obtained from all participants. Carotid intima thickness was measured on all participants using high-resolution B-mode ultrasound. Atherosclerosis was defined as a carotid intima-media thickness of ≥1 mm. Results: The prevalence of atherosclerosis was 10.3% in rural Nallampatti compared to 7.8% in urban Kalapatti. On binary logistic regression analysis, diabetes and hypertension were associated with atherosclerosis in rural areas, but this significance disappeared after adjustment for confounding factors. In urban areas, diabetes appeared to be significantly associated with atherosclerosis even after adjustment for confounding factors. Conclusion: Our data suggest a surprisingly increased prevalence of atherosclerosis in a rural farming population even though traditional risk factors for atherosclerosis such as diabetes and hypertension did not show a significant association after adjustment for confounding factors. If confirmed, this provides a rationale to do large-scale studies to explore the role of nontraditional risk factors in rural India that could have an impact on atherosclerosis and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Introduction: Over the past two decades, India has witnessed a staggering increase in the incidence and mortality of ST-elevation myocardial infarction (STEMI). Indians have higher rates of STEMI and younger populations that suffer from it when compared with developed countries. Yet, the recommended reperfusion therapy with fibrinolysis and percutaneous coronary intervention is available only to a minority of patients. This gap in care is a result of financial barriers, limited healthcare infrastructure and poor knowledge and accessibility of acute medical services for a majority of its population. Methods and analysis: This is a prospective, multicentre, 'pretest/post-test' quasi-experimental, community-based study. This programme will use a 'hub-and-spoke' model of an integrated healthcare network based on clusters of primary-care health clinics, small hospitals and large tertiary-care facilities. It is an 'all-comers' study which will enrol consecutive patients presenting with STEMI to the participating hospitals. The primary objectives of the study is to improve the use of reperfusion therapy and reduce the time from first medical contact to device or drug in STEMI patients; and to increase the rates of early invasive risk stratification with coronary angiography within 3-24 h of fibrinolytic therapy in eligible patients through changes in process of care. Outcomes will be measured with statistical comparison made before and after implementing the TN-STEMI programme. The estimated sample size is based on the Kovai Erode Pilot study, which provided an initial work on establishing this type of programme in South India. It will be adequately powered at 80% with a superiority margin of 10% if 36 patients are enrolled per cluster or 108 patients in three clusters. Thus, the enrolment period of 9 months will result in a sample size of 1500 patients. Ethics: This study will be conducted in accordance with the ethical principles that have their origin in the current Declaration of Helsinki and 'ethical guidelines for biomedical research on human participants' as laid down by the Indian Council for Medical Research. All participating hospitals will still obtain local ethics committee approval of the study protocol and written informed consent will be obtained from all participants. Dissemination and results: Our findings will be reported through scientific publications, research conferences and public policy venues aimed at state and local governments in India. If successful, this model can be extended to other areas of India as well as serve as a model of STEMI systems of care for low-income and middle-income countries across the world. Registration: Trial is registered with Clinical trial registry of India, No: CTRI/2012/09/003002. [ABSTRACT FROM AUTHOR]

Background: Using technology to track endemic areas of communicable diseases is possible nowadays. Effectual use of such facilities, especially in developing countries, will increase earlier detection of cases as well as aid in the formulation of effective prevention strategies., Methods: A retrospective data analysis was carried out by collecting the details of patients presented with positive dengue serology, during the outbreak season in the second half of 2012, at Kovai Medical Center and Hospital, Coimbatore, India. Clinical variables were analysed statistically using SPSS 20 and geographical mapping of the cases was carried out using EPI INFO 7 software., Results: 1004 dengue positive cases were identified during the study period. Geographical mapping of the case clusters showed specific areas in the city as well as neighbouring districts, which were an indirect evidence of the causative mosquito's endemic breeding places. Overall mortality noted in this group was 1.3% and mortality in cases with severe thrombocytopenia was 4 in 1000 cases. Severe thrombocytopenia (Plat≤ 10,000) on admission increased odds ratio for mortality i.e. around 10 times higher than the rest of the cohorts., Conclusions: Identification of endemic mosquito breeding places and implementation of proper preventive measures is always a crucial step in the prevention of further outbreaks. Effective registry using softwares by tertiary care hospitals will be obligatory to track the location of the cases as these hospitals are the nodal point of care for most of the cases in developing countries.