TO STUDY THE USE OF GUIDELINES IN STATINS PRESCRIPTION AT TERTIARY CARE CENTRE OF NORTH INDIA

Background: To study the use of guidelines in statins prescription at tertiary care centre of North India Methods: Study was conducted on Patients with indications for statins presenting to cardiology OPD,Medicine OPD and Endocrinology OPD and started on statins at PGIMER, Chandigarh, within a period of 9 months. Results: In our study, 81.9% of total study population were receiving statins according to guideline and 18.1% were receiving statins not according to guideline. In the primary prevention group,91(83.5%) patients were receiving statins according to guideline and 18(16.5%) were receiving not according to guideline. In the secondary prevention group, 108(80.6%) patients were receiving statins according to guideline and 26(19.4%) patients were receiving statins not according to guideline. Concluded: In our study, more than two third of patients in our study were receiving prescriptions according to guideline Keywords: Statin, Guideline, Use

An Analytical Study to Explore Iron Stores in a Population of Nowshera Based on Age and Gender Perspective

OBJECTIVES: To analyze the impact of age and gender on iron stores in a population of the Nowshera region. METHODOLOGY: This cross sectional study was conducted in the Department of Pathology Qazi Hussain Ahmed Medical Complex Nowshera from 1st January 2019 to 31st March 2020. All patients were selected by convenience sampling in the Pathology department irrespective of age and gender. Both descriptive and inferential statistics were applied to analyze data by the latest SPSS version 25. RESULTS: Out of the total study population males were 70 (27.1%) and females 188 (77.9%) with median age 30 years. The median ferritin level was 12.8 ng/ml. Out of total, 142 (55%) of cases were with serum ferritin less than 15ng/ml. A significant (p=0.03) gender based median ferritin level difference was observed with 1.5 times more probability of low iron stores in females as compared to males (OR=1.5). No statistically significant difference in body iron stores exists in different age groups. CONCLUSION: A significant difference was noted in the iron stores in gender groups and the probability of depleted/low iron stores was higher in female gender as compared to male gender in all age groups in our population.

Coexisting Morbidity Burden in Hospitalized Elderly Patients with New-Onset Heart Failure vs Acutely Decompensated Chronic Heart Failure

Coexisting morbidities (CM) are common in patients with heart failure (HF). This study evaluated the CM burden and its clinical significance in elderly hospitalized patients with new-onset (De-novo) HF (n = 84) and acutely decompensated chronic HF (ADCHF) (n = 122). All had HF symptoms associated with: (a) LVEF <50%, or, (b) left ventricular ejection fraction (LVEF) ≥50% and NT-proBNP ≥300 pg/mL. The primary endpoint was the composite of all-cause death/HF rehospitalization at 6 months. Age was similar between patients with new-onset HF and ADCHF [82 (12.5) vs 80 (11) years, respectively; P = .549]. The CM burden was high in both groups. However, the number of CM [3 (2) vs 4 (1.75)] and the prevalence of multimorbidity [CM ≥2; 65 (77.4%) vs 108 (88.5%)] were lower in new-onset HF ( P = .016 and P = .035, respectively). The survival probability without the primary endpoint was higher in new-onset HF than in ADCHF ( P = .001) driven by less rehospitalizations ( P = .001). In the total study population significant primary endpoint predictors were red blood cell distribution width (RDW), urea, and coronary artery disease (CAD) prevalence (AUC of the model =.7685), whereas significant death predictors were RDW, urea, and the number of CM (AUC = .7859), all higher in ADCHF. Thus, the higher CM burden in ADCHF than in new-onset HF most likely contributed to the worse outcome.

Relationship between C-Reactive Protein and Cardiovascular Diseases in Patient with ESRD

Background- Cardiovascular mortality is significantly higher in ESRD patient.There are various risk factors for development of cardiovascular diseases including traditional risk factors, factors unique to ESRD patients and emerging risk factors.It is believed that their combined actions are integrated in the progression of atherosclerosis and inflammation plays a central role. C-reactive protein is a valuable marker of inflammation. Determination of serum creactive protein levels may be a useful predictor of cardiovascular diseases in ESRD patients Objective-To find out relationship between c-reactive protein and cardiovascular diseases. Methods- This cross sectional study was carried out into department of Nephrology, Dhaka Medical College Hospital, Bangladesh following fulfillment of inclusion and exclusion criteria. For analytical purpose total study population were divided into two groups on the basis of creactive protein level. Patients having c-reactive protein £6 mg/L were considered as group A and >6 mg/L were considered as Group B. The differences between groups were analyzed by unpaired t-test, fisher’ exact test or chi-square (X2) test. Multivariable regression analysis was done to see the association between c-reactive protein and cardiovascular diseases. Results- Patients with raise c-reactive protein have significantly higher cardiovascular disease than that of normal c-reactive protein. Multivariable linear regression analysis after adjusting for age, sex, smoking and diabetes shows that subject with CRP £6 mg/L vs >6 mg/L had 1.51 (95% CI 1.02 to 2.19) times increase risk of having cardiovascular disease. Conclusion- Inflammatory process has a role in development of cardiovascular diseases in ESRD patient. J Shaheed Suhrawardy Med Coll 2020; 12(2): 95-99

Interaction Between Retinol Intake and ISX rs5755368 Polymorphism in Colorectal Cancer Risk: A Case-control Study Among the Korean Population

There is limited evidence about the interaction between retinol intake and the intestine-specific homeobox (ISX) rs5755368 polymorphism in colorectal cancer (CRC) risk. We conducted a hospital-based case-control study to examine whether the ISX rs5755368 genotypes are associated with the effect of dietary retinol consumption on CRC risk. First, to identify the association between dietary retinol and CRC risk, we recruited 923 CRC patients and 1846 controls. Dietary retinol intake was assessed using a semiquantitative food frequency questionnaire. For genetic analysis, genotype data were available for 1419 patients (600 cases and 819 controls) out of the total study population. ISX rs5755368 genotyping was performed using an Illumina MEGA-Expanded Array. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using unconditional logistic regression models. Retinol intake was inversely associated with the development of CRC (OR = 0.49; 95% CI = 0.37–0.63) after adjusting for confounders. Patients with homozygous AA genotype of the ISX rs5755368 polymorphism were less likely to have CRC risk than subjects carrying the G allele (AG+GG) (OR = 0.76; 95% CI = 0.58–0.99). Additionally, a 68% reduced risk of CRC was related to the highest retinol intake among those carrying the rs5755368 AA genotype compared to the risk of participants carrying the G allele consumed the lowest retinol intake (OR = 0.32; 95% CI = 0.20–0.53; P interaction=0.026). In conclusion, our study confirmed a protective role of retinol intake in CRC risk reduction. Moreover, this association was strengthened significantly among individuals carrying the homozygous AA genotype of the ISX rs5755368 polymorphism.

Baloncesto y valores para menores hospitalizados. Percepción de las familias y personal sanitario (Basketball and values for hospitalized minors. Family perception and Health care personnel)

En baloncesto, cuando se practica con menores, no puede obviarse el componente educativo, al margen de las habilidades tácticas y técnicas que lo caracterizan. Desde la perspectiva de educar a través del deporte, se implantó el “Programa infantil de baloncesto en hospitales” de la Fundación Real Madrid para contribuir a la formación y bienestar de los menores ingresados. Esta actividad fue totalmente adaptada a las características de los menores y al contexto en donde se desarrolló. Dada la importancia de los familiares y personal sanitario, el objetivo principal de este estudio fue conocer la percepción y grado de satisfacción de estos dos colectivos en cuanto al programa mencionado. Se realizó una investigación de tipo descriptivo. La población total del estudio fue de 115 personas, de las cuales 70 fueron familiares y 45 fueron personal sanitario. Se utilizó un cuestionario realizado ad hoc con un total de 29 ítems. Los resultados revelaron una gran satisfacción de los participantes sobre el desarrollo del Programa, valorándolo como una actividad deportiva, educativa y lúdica. Destacaron el fomento de valores como el compañerismo, la motivación, el respeto y la autoestima. Resaltaron la labor del profesorado y la capacidad de adaptación de las actividades y juegos planteados. Por otro lado, manifestaron la necesidad de más sesiones semanales, mayor tiempo de duración de éstas y mejoras en las instalaciones donde se desarrollaron las actividades. Como conclusión, en opinión de los participantes, el Programa infantil de baloncesto en hospitales fomentó valores educativos a través de la práctica del baloncesto. Summary. In basketball, when practiced with minors, the educational component cannot be ignored, regardless of the tactical and technical skills that characterize it. From the perspective of educating through sport, the "Children's Basketball Program in Hospitals" of the Real Madrid Foundation was implemented to contribute to the training and well-being of minors admitted. This activity was fully adapted to the characteristics of the minors and the context in which it took place. Given the importance of family members and health personnel, the main objective of this study was to know the perception and degree of satisfaction of these two groups regarding the aforementioned program. A descriptive research was carried out. The total study population was 115 people, of whom 70 were family members and 45 were health personnel. A questionnaire was used ad hoc with a total of 29 items. The results revealed a great satisfaction of the participants about the development of the program, valuing it as a sport, educational and recreational activity. They highlighted the promotion of values such as team-spirit, motivation, respect and self-esteem. They highlighted the work of the teachers and the ability to adapt to the activities and games proposed. On the other hand, they expressed the need for more weekly sessions, longer duration of these and improvements in the facilities where the activities were developed. In conclusion, in the opinion of the participants, the children's basketball program in hospitals fostered educational values through the practice of basketball.

Serum Sodium Concentration and Increased Risk for Primary Epiretinal Membrane

Aims: To examine the prevalence of primary epiretinal membranes (ERMs) and associated systemic factors.Methods: The cross-sectional, community-based Tongren Health Care Study enrolled participants who received regular health examinations in the Beijing Tongren Hospital from 2017 to 2019. Using fundus photographs, retinal specialists assessed the presence of ERMs and their systemic associations.Results: Primary ERMs were detected in 841/22820 individuals, with a prevalence of 3.7% [95% confidence intervals (CI): 3.4–3.9%] in the total study population (mean age: 44.5 ± 13.8 years) and 6.5% (95% CI: 6.1–7.0%) in individuals aged 40+ years. In multivariable analysis, a higher ERMs prevalence was associated with older age [odds ratio (OR): 1.10; P &lt; 0.001], higher serum cholesterol concentration (OR: 1.14; P = 0.003) and higher serum sodium concentration (SSC) (OR: 1.12; P &lt; 0.001). In women, a higher SSC, even within the normal range, was associated with an increased risk of ERMs (OR: 1.19; P &lt; 0.001). Female participants with an SSC of 144–145mmol/L as compared with those with an SSC of 135–137 mmol/L had a 5-fold increased odds of having ERMs (All women: OR: 5.33; P &lt; 0.001; Women aged 40+years: OR: 4.63; P &lt; 0.001).Conclusion: Besides older age and higher serum cholesterol concentration, a higher SSC, even if within the normal range, was independently associated with a higher ERM prevalence in women.

Gender-Specific Differences of Renal Heat Tolerance in Older Adults during Heat Waves

<b><i>Background:</i></b> Heat waves are known to cause increased morbidity and mortality in susceptible populations like old and functionally impaired people. The objective of the study was to assess renal tubular stress, a predictor for development of acute kidney injury, during heat waves in Central Europe. As a marker of renal tubular stress tissue inhibitor of metalloproteinases-2 [TIMP-2]·insulin-like growth factor binding protein-7 [IGFBP7], a new FDA-cleared renal tubular stress biomarker, was used. <b><i>Materials and Methods:</i></b> 68 residents from facilities of sheltered housing with urine samples collected at heat waves in 2015 and at control visits were included. Urinary [TIMP-2]·[IGFBP7] was compared between the heat waves and the control visits. Multivariate linear models were adjusted for age, frailty index, and functional comorbidity index. <b><i>Results:</i></b> The median age was 82.0 years, 82.3% were women. The percentage of elevated levels of urinary [TIMP-2]·[IGFBP7] (&#x3e;0.3 [ng/mL]²/1,000) in the total study population was higher at the heat waves than at the control visits (25.0% vs. 17.7%). The effect of the heat waves on urinary [TIMP-2]·[IGFBP7] was stronger in men than in women: The percentage of elevated levels was 75.0% in men and 14.3% in women. In the multivariate analysis, the mean urinary [TIMP-2]·[IGFBP7] was 0.48 (95% CI 0.25; 0.70) (ng/mL)²/1,000 higher in men than in women. Except gender, a number of additional variables did not show an association with urinary [TIMP-2]·[IGFBP7] at the heat waves or the control visits. <b><i>Conclusions:</i></b> At heat waves, urinary [TIMP-2]·[IGFBP7] was elevated and higher in men than in women. This suggests gender-specific differences in renal heat tolerance in older people.

Use of Long-Term Care Decreased Over Time Among the Oldest-Old With and Without Dementia - A Register-Based Study

Care policies for older adults emphasize aging-in-place and home care over residential long-term care (LTC). We explore how the use of residential LTC in the last five years of life among people with and without dementia changed between those who died in 2001, 2007, 2013, and 2017 in Finland. Retrospective data drawn from the national health and social care registers include all those who died aged 70+ in 2007, 2013, and 2017, plus a 40% random sample from 2001 (N=128 050). Negative binomial regression analysis was used to estimate the association of dementia with LTC use during the last five years of life (1825 days). The independent variables included dementia, age, marital status, annual income, education, and chronic conditions. In the total study population, the proportion of LTC users and the mean number of days in LTC increased until 2013, after which it decreased. Changes in LTC use differed between different age groups and by dementia status. Over time, the decrease in round-the-clock LTC use was steep in those aged 90≤ with dementia and in people aged 80≤ without dementia. The individual factors related to morbidity and sociodemographic factors did not explain these results. The changes in LTC care policy may have contributed to the decrease in LTC use among the oldest. However, according to national statistics, the availability of formal home care has not increased. This development may suggest that the oldest-old and those with dementia – a highly vulnerable group – are left without proper care.

Randomized controlled trial of ragweed sublingual immunotherapy tablet in the subpopulation of Canadian children and adolescents with allergic rhinoconjunctivitis

Background Post hoc analyses of randomized placebo-controlled trials have demonstrated efficacy and tolerability of the ragweed sublingual immunotherapy (SLIT)-tablet in Canadian adults with ragweed pollen-induced allergic rhinitis/conjunctivitis (AR/C). This post hoc analysis evaluated the efficacy and tolerability of the ragweed SLIT-tablet in the subpopulation of Canadian children and adolescents with AR/C in a previously described randomized, double-blind, placebo-controlled trial. Methods The trial (NCT02478398) was conducted in North American and European children/adolescents ages 5–17 years with ragweed pollen-induced AR/C with or without asthma (FEV1 ≥ 80% predicted). Participants were randomized to daily ragweed SLIT-tablet (12 Amb a 1-U) or placebo for up to 28 weeks. The primary endpoint was the average total combined score (TCS; sum of rhinoconjunctivitis daily symptom score [DSS] and daily medication score [DMS]) during peak ragweed pollen season (RPS). Key secondary endpoints were TCS during the entire RPS, and DSS and DMS during peak RPS. Post hoc analyses of the primary and key secondary endpoints were conducted in the subpopulation of Canadian participants. Results Of the 1025 randomized participants, 246 (SLIT-tablet, n = 116; placebo, n = 130) were in the Canadian subpopulation. In the total study population, relative TCS (95% CI) improvement with ragweed SLIT-tablet versus placebo was − 38.3% (− 46.0%, − 29.7%; least square [LS] mean difference, − 2.73; P < 0.001) during peak RPS. In the Canadian subpopulation, relative TCS improvements with ragweed SLIT-tablet versus placebo were − 40.8% (− 54.5%, − 20.2%; LS mean difference, − 1.59; P = 0.001) during peak RPS and − 36.6% (− 50.2%, − 16.5%; LS mean difference, − 1.36; P = 0.002) during the entire RPS. DSS and DMS during peak RPS in the Canadian subpopulation improved with SLIT-tablet versus placebo by − 30.6% (− 45.2%, − 7.7%; LS mean difference, − 0.94; P = 0.010) and − 77.2% (− 97.5%, − 44.2%; LS mean difference, − 0.66; P = 0.003), respectively. No events of anaphylaxis, airway compromise, intramuscular epinephrine administration, eosinophilic esophagitis, or severe treatment-related systemic allergic reactions were reported in the overall population or Canadian subpopulation. Conclusion Efficacy and safety of the ragweed SLIT-tablet in Canadian children/adolescents with ragweed pollen-induced AR/C was consistent with the total study population. The ragweed SLIT-tablet resulted in clinically meaningful improvement in symptoms, decreased symptom-relieving medication use, and was well tolerated in Canadian children/adolescents. Trial registration: clinicaltrials.gov, NCT02478398. Registered June 23, 2015, https://clinicaltrials.gov/ct2/show/NCT02478398?term=NCT02478398&draw=2&rank=1