P1945High levels of unawareness and suboptimal management of hypertension in India: data from a large community based study

Background

Hypertension is the most common cause of the rising cardiovascular disease (CVD) epidemic in India. However, despite availability of proven therapies management remains sub-optimal.

Purpose

To determine the hypertension control rates and associated factors among adults with known hypertension in urban and rural India.

Methods

We conducted a representative population based cross-sectional survey among 12243 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using a multistage cluster random sampling technique. Trained personnel collected the data using an interviewer administered questionnaire, measured blood pressure, conducted anthropometry and collected bio-samples. Hypertension was defined as known hypertension (self-report of physician diagnosis) or systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg. Control was defined as SBP <140 mmHg and DBP <90 mmHg among those with known hypertension. The associations were measured using logistic regression.

Results

The mean (±SD) age of participants was 47.7 (±12.5) years, women comprised 54%. The age-standardized prevalence of hypertension was 29.0% (95% CI: 28.2- 29.8) and known hypertension was 14.0% (13.4- 14.6). Among all hypertensives 38.6% (37.0–40.2) were on treatment and 26.2% (24.6–28.0) had their blood pressure controlled, while among known hypertensives 79.8% (77.8–81.7) were on treatment and 55.7% (53.3–58.1) had their blood pressure controlled. In multivariate analysis, participants from North Indian site [OR: 1.9 (1.6–2.3)], urban residents [1.3 (1.1–1.6)], younger participants [1.5 (1.2–1.8)], men [2.0 (1.5–2.6)], those with low socio-economic status [1.6 (1.1–2.3)], without comorbidities and those without a family history hypertension were more likely to be unaware about their hypertensive status and less likely to take treatment. Hypertension control was significantly higher in participants from South Indian site [1.5 (1.2–1.0)], the highly educated [1.6 (1.1–2.4)], those without heart diseases [1.8 (1.1–3.1)], those without central obesity [1.4 (1.1–1.9)], physically active individuals [1.5 (1.1–2.0)] and current non-alcohol users [1.9 (1.3–2.6)].

Conclusions

Many individuals with hypertension remain unaware and sub-optimally managed. This warrants the implementation of tailored public education to raise awareness, complemented by active screening for the early detection and effective management of hypertension, in order to stem the rising tide of preventable CVD in India.

Acknowledgement/Funding

Unrestricted educational grant from Eli Lilly under the Lilly NCD Partnership

Cancer trends in India: A review of population-based cancer registries (2005-2014)

There is a constant rise in cancer cases, but the trends and pattern vary according to the geographical region. The aim of this brief research was to present an update of all cancer incidences through age-adjusted rates and their changes in different regions of the country. The data for this study were obtained from published reports of 28 population-based cancer registries (2005-2014) in India. Among males, currently, East/Northeast region ranked first, on the basis of incidence of cancer cases. Out of 28 registries, 11 registries encountered lung cancer as the leading site. Currently, East/Northeast regions were ranked first on the basis of incidence of cancer cases among females. Our study showed that 20 registries among the 28 had breast cancer as the leading one. Thus, the present overview revealed that all cancers in both males and females are consistent and had a high incidence in East/Northeast region of the country.

Assessment of tropospheric ozone at an industrial site of Chennai megacity

This paper presents the temporal variation in surface-level ozone (O₃) measured at Gummidipoondi near Chennai, Tamilnadu. The site chosen for the present study has high potential for ozone generation sources, such as vehicular traffic and industrial activities. The site is also located near a hazardous waste management facility. The key sources of nitrogen oxides (NO_x), which are considered to be an important precursor of O₃, include hazardous waste incineration, trucks bringing the hazardous wastes, and vehicles plying on the nearby National Highway 16 (NH 16). The measurements clearly showed diurnal variation, with maximum values observed during the noon hours and minimum values observed when solar radiation was less. The data showed a marked seasonal variation in O₃, with the highest hourly average O₃ concentration (497.2 µg/m³) in the summer season. Consequently, in order to identify the long-range transport sources adding to the increased O₃ levels, backward trajectories were computed using the Hybrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) model. It was found that the polluted air mass originated from the Southeast Asian region and the Indo-Gangetic Plain. The polluted air mass, which advected large amounts of carbon monoxide (CO) plumes, was analyzed using the Measurement of Pollution in the Troposphere (MOPITT) retrievals. The correlations of O₃ with temperature (r = 0.746; P < 0.01) and solar radiation (r = 0.751; P < 0.01) were strongly positive, and that with NO_x was found to be negative. Stronger correlation of O₃ with NO_x was observed during pre-monsoon months (r = 0.627; P < 0.01) and following hours of photochemical reactions. There were substantial differences in concentrations between weekdays and weekends, with higher nitric oxide (NO) and nitrogen dioxide (NO₂), but lower O₃, concentrations on weekdays. A substantial weekday-weekend difference in O₃, which was higher on weekends, appears to be attributable to lower daytime traffic activity and hence reduced emissions of NO_x to a "NO_x-saturated" atmosphere. Implications: The assessment of ground-level ozone in an industrial area with hazardous waste management facility is very important, as there is high possibility for more generation of tropospheric ozone. Since the location of the study area is coastal, wind plays a major role in O₃ transportation; hence, the effects of wind speed and wind direction have been studied in different seasons. When compared with the other studies carried out in different places across India, the present study area has recorded much greater O₃ mixing ratio. This study can be useful for setting up control strategies in such industrial areas.

Quantum chemical studies and spectroscopic investigations on 22-amino-3-methyl-5-nitropyridine by density functional theory

Quantum chemical calculations on energy and molecular structure of 2-amino-3-methyl-5-nitropyridine (2A3M5NP) have been attempted by implementing DFT/B3LYP method using 6-311G (d,p), 6-311G++ (d,p) and cc-pVTZ basis sets. The optimized geometry and the vibrational analysis for energetically most stable configuration, are carried out theoretically by using B3LYP/cc-pVTZ basis set. The computed vibrational frequencies were scaled by using scaling factors and compared with the experimental Fourier Transform Infra-Red (FTIR) solid phase spectrum in the region 4000-400 cm⁻¹ and FT-Raman spectrum in the region 4000-100 cm⁻¹. The complete vibrational assignments, analysis and correlation of fundamental modes of the compound have been carried out using the potential energy distribution (PED). The intramolecular charge transfer, hyperconjugative interaction of the compound is investigated from natural bonding orbital (NBO) analysis. The UV-Visible spectrum of 2A3M5NP was obtained with ethanol as a solvent. The electronic properties such as HOMO (Highest Occupied Molecular Orbital) and LUMO (Lowest Unoccupied Molecular Orbital) energies are determined by B3LYP/cc-pVTZ basis set. The electronic absorption spectrum of the compound was studied from UV-Visible analysis by using time-dependent density functional theory (TD-DFT). The electron density distribution and chemical reactive sites of 2A3M5NP were analyzed from molecular electrostatic potential (MEP) analysis and frontier molecular orbital (FMO) analysis.

Convolutional Neural Network for Automated FLAIR Lesion Segmentation on Clinical Brain MR Imaging

BACKGROUND AND PURPOSE

Most brain lesions are characterized by hyperintense signal on FLAIR. We sought to develop an automated deep learning-based method for segmentation of abnormalities on FLAIR and volumetric quantification on clinical brain MRIs across many pathologic entities and scanning parameters. We evaluated the performance of the algorithm compared with manual segmentation and existing automated methods.

MATERIALS AND METHODS

We adapted a U-Net convolutional neural network architecture for brain MRIs using 3D volumes. This network was retrospectively trained on 295 brain MRIs to perform automated FLAIR lesion segmentation. Performance was evaluated on 92 validation cases using Dice scores and voxelwise sensitivity and specificity, compared with radiologists' manual segmentations. The algorithm was also evaluated on measuring total lesion volume.

RESULTS

Our model demonstrated accurate FLAIR lesion segmentation performance (median Dice score, 0.79) on the validation dataset across a large range of lesion characteristics. Across 19 neurologic diseases, performance was significantly higher than existing methods (Dice, 0.56 and 0.41) and approached human performance (Dice, 0.81). There was a strong correlation between the predictions of lesion volume of the algorithm compared with true lesion volume (ρ = 0.99). Lesion segmentations were accurate across a large range of image-acquisition parameters on >30 different MR imaging scanners.

CONCLUSIONS

A 3D convolutional neural network adapted from a U-Net architecture can achieve high automated FLAIR segmentation performance on clinical brain MR imaging across a variety of underlying pathologies and image acquisition parameters. The method provides accurate volumetric lesion data that can be incorporated into assessments of disease burden or into radiologic reports.

Nanoscopic insights of saline water in carbon nanotube appended filters using molecular dynamics simulations

Nanotube appended membranes are shown to be very promising due to their ultrafast water transport and very high salt rejection ability. Using classical molecular dynamics, the present study reports the nanoscopic assessment of various molecular events for nanotube-based desalination, which might be useful for nanoscale devices during process operation at the macroscopic scale. The characteristics of water and ion flow are discussed with varied strength of pressure gradient and salt concentration for different scales of confinement. The results revealed that the membranes comprising nanotubes of 1.0-1.1 nm diameter can be optimized for efficient water desalination with more than >95% salt rejection. Furthermore, the anomalies in water flux through nanotubes are linked with the hydration characteristics of ions inside CNTs. The results show the maximum hydration of confined ions inside the nanotubes, which indicated the minimum permeability of water due to freezing effects. Furthermore, the MD results revealed that akin to bulk phases, the mass transport through nanotubes can be linked with the component diffusivity in the medium. It has been demonstrated that not only the diffusivities of water and ions, but even the gradient of water to ion diffusivity might be utilized to predict and explore the experimental observations, which might be helpful in optimizing the operational regime in nanotube-based filtrations. Moreover, the thermodynamic characteristics of the flow are discussed in terms of the entropy of water and ions using the robust two-phase thermodynamic (2PT) method. The results reflect that the entropy of water is linked to the distortion of the hydrogen bond network inside the nanotube confinement, at the nanotube-water interface and at the bulk solution, whereas the entropy of ions seems to be majorly dominated by their oscillation. Also, the interconnection of hydration structure, mass flux and the diffusivity of water and ions along with their thermodynamic origin are discussed.

Tuberculosis-diabetes screening: how well are we doing? A mixed-methods study from North India

Setting

Public health care facilities in Sonipat District, Haryana State, India.

Objectives

To assess 1) the proportion of tuberculosis (TB) patients screened for diabetes mellitus (DM) and vice versa, 2) factors associated with screening, and 3) the enablers, barriers and solutions related to screening.

Design

A mixed-methods study with quantitative (cohort study involving record reviews of patients registered between November 2016 and April 2017) and qualitative (interviews of patients, health care providers [HCPs] and key district-level staff) components.

Results

Screening for TB among DM patients was not implemented, despite documents indicating that it had been. Of 562 TB patients, only 137 (24%) were screened for DM. TB patients registered at tertiary and secondary health centres were more likely to be screened than primary health centres. Low patient awareness, poor knowledge of guidelines among HCPs, lack of staff and inadequate training were barriers to screening. Enablers were the positive attitude of HCPs and programme staff. The key solutions suggested were to improve awareness of HCPs and patients regarding the need for screening, training of HCPs and wider availability of DM testing facilities.

Conclusion

The implementation of bidirectional screening was poor. Adequate staffing, regular training, continuous laboratory supplies for DM diagnosis and widespread publicity should be ensured.

Clinical Diversity of CNS Cryptococcosis

BACKGROUND

Though cryptococcal meningitis (CM) is recognized as a disease of the immunocompromised, studies have implicated that it also affect immunocompetent patients.

METHODOLOGY

This was a cross sectional study conducted in the Department of Medicine of a tertiary teaching institution in North India. All the patients diagnosed with CM on the basis of detection of cryptococcal antigen or the presence of capsulated budding yeast cells on India ink preparation, from April 2009 to March2015 were included in the study. Demographical profile, clinical presentation, predisposing factors, CSFcharacteristics, imaging abnormalities and in patient outcome were noted and analyzed.

RESULTS

Among the 40 patients diagnosed with CM, 62.5% of them were males. Patients who were immunocompetent constituted 20%, those with predisposing factors other than HIV were 25% and55% had HIV infection (initial presentation in 59%). Mean age of presentation was 44.75 ± 15.58 years. Mean duration of symptoms in all three groups varied from few days to 4-5 weeks. Clinical presentations included fever (16), headache (14), altered sensorium (16), seizures (5), paraparesis (4), hemiparesis (2), lateral rectus palsy (3), VII nerve palsy (2), bilateral vision loss with ptosis (1) and ataxia (1). Neck stiffness was present in 50% patients of immunocompetent group, 45.45% of HIV patients and none in the 3rd group. Acellular CSF (37.5%) was not unusual. Mean CSF white cell count in HIV patients, in other immunocompromised patients and immunocompetent patients were 100± 158.53, 36.88 ± 92.43 and 32.5 ± 62.05 /mm3 respectively which was predominantly lymphocytic. Mean CSF protein were 136.73 ± 139.82, 62.67 ± 51.11 and 152.29 ± 218.24 g/dl in these groups. Abnormalities detected on imaging included, meningeal enhancement, encephalomalacia, infarct, cerebellitis, hydrocephalus, cord hyper intensities and cervical spine intramedullary lesion. Mortality rate in CM patients was 20%. On mortality analysis, death was mostly attributed to the primary disease.

CONCLUSIONS

Clinical presentation of CM in both immunocompetent and immunocompromised patients was similar. Though previous studies noted less inflammation in immunocompromised patients, in this series it was noted that both immunocompromised and immunocompetent patients mounted similar inflammatory response. Since the presentation of CM is variable, all cases of meningitis should be screened for the same.

Cerebrovascular Manifestations of Neurosarcoidosis: An Underrecognized Aspect of the Imaging Spectrum

Involvement of the central nervous system by sarcoidosis, also referred to as neurosarcoidosis, is seen clinically in about 5% of patients with systemic disease. CNS involvement most frequently affects the leptomeninges and cranial nerves, though the ventricular system, brain parenchyma, and pachymeninges may also be involved. Even though the involvement of the intracranial vascular structures is well-known on postmortem studies, there is scant literature on imaging manifestations secondary to the vessel wall involvement, being confined mostly to isolated case reports and small series. The authors present a review of various cerebrovascular manifestations of neurosarcoidosis, along with a brief synopsis of the existing literature.

Molecular Facts on the Structure and Dynamics of Electrolyte Species in Cu-Cl Cycle for Hydrogen Generation: An Insight from Molecular Dynamic Simulations

The Cu complex, which is the key chemical species in well-known Cu-Cl hybrid thermochemical cycles and also in numerous metal hydrometallurgical and sedimentary deposit processes, displays a wide variety of structural and dynamical characteristics that are further complicated by the presence of multiple oxidation states of Cu ions with different coordination chemistries, therefore they are difficult to explore from experiments alone. In this article, an attempt has been made to understand the coordination behavior of the Cu complex using MD simulations. The study provides compelling evidence of the experimentally observed multiple stoichiometries of Cu ions, i.e., 1:6:0, 1:5:1, and 1:4:2 for Cu⁺:H₂O:Cl^- and 1:6:0 for Cu²⁺:H₂O:Cl^-. The presence of the anionic Cu complex, [Cu⁺Cl₂]^-·2H₂O, [Cu⁺Cl₂]^-·3H₂O, [Cu²⁺Cl₃]^-·H₂O, and [Cu²⁺Cl₃]^-·2H₂O, was captured in the presence of excess chloride ions. Furthermore, the probability distribution profiles have been estimated to determine the most possible complex in the considered systems. The results establish structural and dynamical reformation of the Cu complex with change in the salt concentration or variation in the solvent medium in which they are dissolved. Moreover, the structure and kinetics of the Cu ions in the Cu-Cl electrolyzer have been explored over a large range of the electric field by extending the simulated systems for varied strengths of the electric fields. It has been observed that with an increase in the strength of the electric field, the water molecules lose their coordination strength with central Cu ions, which, on the other hand, results in a significant change in the structure of the captured complex. The diffusion dynamics of the ions is altered while applying the electric field, which is furthermore modified while increasing the strength of electric field beyond a critical limit. In fact, the diffusion mechanism of the ions was seen to be transformed from Brownian-like to linear motion and then to hopping diffusion with the increasing strength of the electric field. To the best of our knowledge, this is the first time when the multiple oxidation states of the Cu ion are explored using MD simulations, and the coexisting pictures of the multiple coordinations and the solvent effects have been clearly revealed. Also to date, the present article is the first one to report the insights of the structure and the dynamics of the ions in the Cu-Cl electrolyzer over a wide range of the electric field. The present studies will be very helpful in understanding the mechanism involved in numerous metal hydrometallurgical and sedimentary deposit processes and to comprehend the analogies involved in the electrode reactions of the Cu-Cl cycle for hydrogen generation.

A randomized controlled clinical trial evaluating the efficacy of zoledronate gel as a local drug delivery system in the treatment of chronic periodontitis: A clinical and radiological correlation

Background

This study aimed to evaluate the efficacy of local drug delivery system of zoledronate (ZLN) gel as an adjunct to scaling and root planing (SRP) for the treatment of human periodontal intrabony defects clinically and radiographically.

Materials and Methods

Forty intrabony defects (three walled and combined defects without involving furcation) in moderate to severely affected forty chronic periodontitis patients (range, 30-50 years) were randomly divided into two groups and treated either with 0.05% ZLN gel (ZLN n = 20; 1 dropout) or placebo gel (control group [CG] n = 20) after SRP. Clinical parameters such as plaque index (PI), gingival index (GI), tooth-specific pocket probing depth (T_s PPD), and clinical attachment levels (TsCAL) were assessed at baseline and at 3 and 6 months using occlusal acrylic stent. Radiographic parameters were assessed at baseline and 6 months, utilizing "ONIS 2.5 PROFESSIONAL" and "SYNGO" software compatible with DentaScan to measure the volumetric bone changes in intrabony defects.

Results

In intragroup comparisons, both groups showed significant PI and GI reduction (P < 0.001) after treatment at 3 and 6 months. In intergroup comparisons, T_s PPD reduction and T_s CAL gain were significant only in ZLN at 6 months from both baseline and 3 months. Radiographically, significant reduction in defect depth and buccolingual width with volumetric defect gain of 40.24% ± 7.44% in ZLN compared to insignificant gain of 1.60% ± 4.06% in CG was observed at 6 months.

Conclusion

ZLN gel applied subgingivally in intrabony defects resulted in significant improvements both clinically and radiographically.

Dynamic Contrast-Enhanced MRI-Derived Intracellular Water Lifetime (τ i ): A Prognostic Marker for Patients with Head and Neck Squamous Cell Carcinomas

BACKGROUND AND PURPOSE

Shutter-speed model analysis of dynamic contrast-enhanced MR imaging allows estimation of mean intracellular water molecule lifetime (a measure of cellular energy metabolism) and volume transfer constant (a measure of hemodynamics). The purpose of this study was to investigate the prognostic utility of pretreatment mean intracellular water molecule lifetime and volume transfer constant in predicting overall survival in patients with squamous cell carcinomas of the head and neck and to stratify p16-positive patients based upon survival outcome.

MATERIALS AND METHODS

A cohort of 60 patients underwent dynamic contrast-enhanced MR imaging before treatment. Median, mean intracellular water molecule lifetime and volume transfer constant values from metastatic nodes were computed from each patient. Kaplan-Meier analyses were performed to associate mean intracellular water molecule lifetime and volume transfer constant and their combination with overall survival for the first 2 years, 5 years, and beyond (median duration, >7 years).

RESULTS

By the last date of observation, 18 patients had died, and median follow-up for surviving patients (n = 42) was 8.32 years. Patients with high mean intracellular water molecule lifetime (4 deaths) had significantly (P = .01) prolonged overall survival by 5 years compared with those with low mean intracellular water molecule lifetime (13 deaths). Similarly, patients with high mean intracellular water molecule lifetime (4 deaths) had significantly (P = .006) longer overall survival at long-term duration than those with low mean intracellular water molecule lifetime (14 deaths). However, volume transfer constant was a significant predictor for only the 5-year follow-up period. There was some evidence (P < .10) to suggest that mean intracellular water molecule lifetime and volume transfer constant were associated with overall survival for the first 2 years. Patients with high mean intracellular water molecule lifetime and high volume transfer constant were associated with significantly (P < .01) longer overall survival compared with other groups for all follow-up periods. In addition, p16-positive patients with high mean intracellular water molecule lifetime and high volume transfer constant demonstrated a trend toward the longest overall survival.

CONCLUSIONS

A combined analysis of mean intracellular water molecule lifetime and volume transfer constant provided the best model to predict overall survival in patients with squamous cell carcinomas of the head and neck.