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Deepa M, Elangovan N, Venkatesan U, Das HK, Jampa L, Adhikari P, Joshi PP, Budnah RO, Suokhrie V, John M, Tobgay KJ, Subashini R, Pradeepa R, Anjana RM, Mohan V, Kaur T, Dhaliwal RS. Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15). Indian J Med Res 2023; 157:239-249. [PMID: 37282387 PMCID: PMC10438401 DOI: 10.4103/ijmr.ijmr_2615_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 06/08/2023] Open
Abstract
Background & objectives Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods Data were acquired from the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under high-, moderate- and low-risk categories of IDRS. The ROC-AUC for the identification of diabetes was 0.697 (95% confidence interval: 0.684-0.709) for urban population and 0.694 (0.684-0.704) for rural, as well as 0.693 (0.682-0.705) for males and 0.707 (0.697-0.718) for females. MDRF-IDRS performed well when the population were sub-categorized by state or by regions. Interpretation & conclusions Performance of MDRF-IDRS is evaluated across the nation and is found to be suitable for easy and effective screening of diabetes in Asian Indians.
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Affiliation(s)
- Mohan Deepa
- Department of Epidemiology, Diabetes Complications, Chennai, Tamil Nadu, India
| | - Nirmal Elangovan
- Department of Research Operations & Diabetes Complications, Chennai, Tamil Nadu, India
| | | | - Hiranya Kumar Das
- Regional Medical Research Centre, ICMR NE Region, Dibrugarh, Assam, India
| | - Lobsang Jampa
- Directorate of Health Services, Naharlagun, Arunachal Pradesh, India
| | - Prabha Adhikari
- Department of Epidemiology, Yenepoya Medical College, Yenepoya University Campus, Deralakatte, Karnataka, India
| | - Prashant P. Joshi
- Department of General Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | | | - Vizolie Suokhrie
- Directorate of Health & Family Welfare, Government of Nagaland, Kohima, Nagaland, India
| | - Mary John
- Deparment of Internal Medicine, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Karma Jigme Tobgay
- Department of Health Care, Human Services & Family Welfare, Government of Sikkim, Gangtok, Sikkim, India
| | - Radhakrishnan Subashini
- Department of Biostatistics, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Rajendra Pradeepa
- Department of Research Operations & Diabetes Complications, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Tanvir Kaur
- Division of Non-communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Khot RS, Patil A, Rathod BD, Patidar M, Joshi PP. Uncovering the Unusual: A Case of Mixed Connective Tissue Disease With Rare Presentation, Atypical Complications, and Therapeutic Dilemmas. Cureus 2023; 15:e36298. [PMID: 37073214 PMCID: PMC10106112 DOI: 10.7759/cureus.36298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 03/19/2023] Open
Abstract
Mixed connective tissue disease (MCTD) is an overlap syndrome characterized by features of systemic lupus erythematosus, scleroderma, and polymyositis, along with the presence of the U1RNP antibody. A 46-year-old female patient presented with severe anemia, cough, and breathlessness, and was diagnosed with cold agglutinin disease, a type of autoimmune hemolytic anemia (AIHA). Autoimmune workup revealed MCTD by positive antinuclear and U1RNP antibodies. She had bilateral miliary mottling on X-ray and a tree-in-bud appearance on high-resolution computed tomography of the thorax, which were suggestive of pulmonary tuberculosis. Standard therapy with steroids was not advisable. She was subsequently started on anti-tuberculosis treatment (anti-Koch's therapy), followed by steroid therapy and immunosuppressive therapy after three weeks. The patient responded well to treatment, but after two months, she developed cytomegalovirus (CMV) retinitis. Adult-onset CMV disease may occur as a result of primary infection, reinfection, or activation of a latent infection. Although not directly related, it can occur as an atypical association in the setting of immunosuppressive therapy. Morbidity and mortality are significantly increased in this population secondary to infectious potentiation: immunosuppression causes infections, and infections cause AIHA. The management of MCTD and secondary AIHA and immunosuppression poses a therapeutic challenge.
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Rathod BD, Ahirwar AK, Banerjee S, Joshi PP, Khot RS, Dube AH, Kumbhalkar SD, Dabhekar SB. Association of vitamin D with the severity of disease and mortality in COVID-19: Prospective study in central India. Ann Afr Med 2023; 22:117-123. [PMID: 36695233 PMCID: PMC10064909 DOI: 10.4103/aam.aam_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Many factors have been proposed to be associated with the severity of disease and mortality in COVID-19. Vitamin D had recently been reviewed as one of these factors. Aim and Objectives To evaluate the association between Vitamin D and the disease severity and mortality in COVID-19. Materials and Methods After approval from Institutional Ethics Committee, this prospective cohort study was carried out in selected tertiary care teaching medical institutes of Central India. Participants were COVID-19 patients of the age group of 18 years and above admitted during the study period. They were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. Serum level of Vitamin 25(OH) D was measured using chemiluminescent immunoassay. The outcome of the disease was classified as recovery and death during hospitalization. The association of sociodemographic and medical characteristics with treatment outcome was studied using an appropriate statistical test. A full logistic regression model was built for the assessment of the relationship between treatment outcomes with Vitamin D level. Further, one receiver operating characteristic curve was developed to examine the prognostic significance of Vitamin D levels in COVID-19 patients. Results Out of 748 enrolled patients, 44 (5.88%), had severe disease (Group D). A total of 721 cases (96.39%) recovered and were discharged, whereas 27 (3.61%) died during hospitalization. Mean Vitamin D level was found to be significantly different in discharged patients compared to those who were deceased. Increasing age-adjusted odds ratio (AOR) (95% confidence interval [CI]=1.07 [1.02-1.12]), known hypertension AOR (95%CI) = 3.38 (1.13-10.08), and diabetes mellitus AOR (95%CI) =28.5 (6.04-134.13) were found to be significant predictors of death among COVID-19 patients. Increasing Vitamin D level was found to be protective against COVID-19-related death (AOR (95% CI = 0.87 [0.80-0.94]). Conclusion Vitamin D was significantly associated with the disease severity and mortality in COVID-19.
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Affiliation(s)
| | - Ashok Kumar Ahirwar
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | | | - Prashant P Joshi
- Department of General Medicine, AIIMS, Nagpur, Maharashtra, India
| | | | - Amol H Dube
- Department of General Medicine, AIIMS, Nagpur, Maharashtra, India
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Rathod BD, Amle D, Khot RS, Prathipati KK, Joshi PP. Neutrophil-to-Lymphocyte Ratio as a Predictor of Disease Severity and Mortality in Coronavirus Disease 2019: Prospective Study From Central India. Cureus 2022; 14:e23696. [PMID: 35519791 PMCID: PMC9064266 DOI: 10.7759/cureus.23696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Clinical presentation of coronavirus disease 2019 (COVID-19) varies from an asymptomatic state to severe disease characterized by acute respiratory distress syndrome, respiratory failure, thrombosis, and multi-organ dysfunction syndrome. The neutrophil-to-lymphocyte ratio (NLR) has been reviewed as one of the laboratory factors that have been proposed to predict the severity of disease and mortality in COVID-19 pandemic. Aim and objectives: To evaluate the association between NLR and the disease severity and mortality in COVID-19. Materials and methods: After approval from Institutional Ethics Committee, this prospective cohort study was carried out in a tertiary-care teaching medical institute of Central India. COVID-19 patients of the age group 18 years and above admitted during the study period were included. Cases were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. NLR was calculated by doing a complete blood count at the time of hospitalization by the Mindray BC-6000 auto hematology analyzer. The outcome of the disease was classified as recovery and death during hospitalization. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of NLR at admission to predict severe COVID-19 or mortality. Ordinal regression analysis was used to assess the impact of NLR on disease severity and mortality. Results: Mean NLR was significantly higher in the severe COVID-19 group as compared to the mild/moderate group and in deceased as compared to discharged cases. ROC curve analysis revealed NLR to be an excellent predictor of disease severity as well as a prognostic parameter for risk of death. NLR was found to be a significant independent positive predictor for contracting the severe disease (Odd’s ratio 1.396, 95% CI=1.112-1.753, p=0.004) and mortality (Odd’s ratio 1.276, 95% CI=1.085-1.499, p=0.003). Conclusion: High NLR was significantly associated with the disease severity and mortality in COVID-19.
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Khot R, Kumbhalkar SD, Juneja R, Joshi PP. The Development of Ecchymosis after Administration of Convalescent Serum in a Patient with COVID-19 Associated with Thrombocytosis. Eur J Case Rep Intern Med 2021; 8:002782. [PMID: 34671574 DOI: 10.12890/2021_002782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
COVID-19 can have an unpredictable and severe course, leading to many hypotheses regarding its pathophysiology and clinical manifestations. Haematological manifestations are a significant predictor of disease severity. The most common observation is lymphopenia with an increased neutrophil:lymphocyte ratio. Platelets have been implicated in thrombogenic events, but the most frequently reported abnormality is mild thrombocytopenia. Here we present an interesting case of a patient with moderate COVID-19 who presented with cutaneous ecchymoses and thrombocytosis, and discuss this paradox. LEARNING POINTS Bleeding manifestations such as ecchymoses can occur as an idiosyncratic reaction to the administration of convalescent plasma therapy in COVID-19.Thrombocytosis can occur in COVID-19 and could be a contributory factor to disease vasculopathy.
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Affiliation(s)
- Rajashree Khot
- Department of General Medicine, AIIMS, Nagpur, Maharashtra, India
| | | | - Richa Juneja
- Department of Pathology (Haematology), AIIMS, Nagpur, Maharashtra, India
| | - Prashant P Joshi
- Department of General Medicine, AIIMS, Nagpur, Maharashtra, India
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Basu G, Anthony ML, Bakliwal A, Chattopadhyay D, Joshi PP, Arora RK, Mittal RS, Nath UK. Primary anaplastic lymphoma kinase-negative anaplastic large cell lymphoma of cervical spine presenting with quadriplegia: A case report and literature review. Surg Neurol Int 2020; 11:373. [PMID: 33408907 PMCID: PMC7771492 DOI: 10.25259/sni_634_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background: An anaplastic large cell lymphoma (ALCL) involving the cervical spine and leading to quadriplegia is very rare. Case Description: A 48-year-old immunocompetent male presented with quadriplegia that warranted an anterior cervical corpectomy/fusion. He was previously being presumptively treated for cervical disease attributed to tuberculosis. The histopathology and immunohistochemistry revealed an ALCL that was anaplastic lymphoma kinase (ALK) negative. The patient had a favorable response to surgery followed by CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisolone) chemotherapy. Conclusion: ALK-negative ALCL presenting with quadriplegia due to primary involvement of cervical spine is extremely rare, but must be diagnosed and appropriately managed.
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Affiliation(s)
- Garga Basu
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Michael L Anthony
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anamika Bakliwal
- Department of Medical oncology-Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debranjani Chattopadhyay
- Department of Medical oncology-Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prashant P Joshi
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajnish Kumar Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Radhey Shyam Mittal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Uttam Kumar Nath
- Department of Medical oncology-Hematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Waghale RM, Khot RS, Joshi PP. Platelet volume indices: markers of carotid atherosclerosis in type 2 diabetes mellitus? Clinical Diabetology 2020. [DOI: 10.5603/dk.2020.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kumari N, Anthony ML, Durgapal P, Joshi PP, Rajput D, Singh A. Ossifying fibromyxoid tumor: Fine-needle aspiration cytology findings of a rare soft tissue neoplasm. Diagn Cytopathol 2020; 48:396-400. [PMID: 31925994 DOI: 10.1002/dc.24382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 11/12/2022]
Abstract
Ossifying fibromyxoid tumors (OFMTs) are rare tumors of uncertain origin and intermediate (rarely metastasizing) biologic potential, with characteristic morphology of an encapsulated tumor containing polygonal cells in an abundant fibromyxoid matrix surrounded by a peripheral layer of metaplastic lamellar bone. FNA cytology of OFMT has not been sufficiently reported and till date cytological features of only seven cases have been reported so far. We report another case of OFMT in a 55-year-old female presenting with longstanding swelling in thigh. On fine-needle aspiration, a tumor with moderate cellularity and myxoid areas was seen; coupled with compatible radiological findings, a diagnosis of OFMT was suggested. Establishing a correct diagnosis is important as although OFMT is benign in nature, local recurrences or rarely distant metastasis have been seen of this tumor. Hence, a high degree of suspicion with radiological correlation is of utmost importance for identification of this entity.
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Affiliation(s)
- Neha Kumari
- Department of Pathology, AIIMS RISHIKESH, Rishikesh, India
| | | | | | | | - Deepak Rajput
- Department of General Surgery, AIIMS RISHIKESH, Rishikesh, India
| | - Ashok Singh
- Department of Pathology, AIIMS RISHIKESH, Rishikesh, India
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Hazarika N, Vathulya M, Joshi PP, Bhatia R. Congenital erosive and vesicular dermatosis in a young girl: a diagnostic dilemma. Int J Dermatol 2019; 58:e212-e214. [PMID: 31281977 DOI: 10.1111/ijd.14570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Neirita Hazarika
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, India
| | - Madhubari Vathulya
- Department of Burns & Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Prashant P Joshi
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, India
| | - Riti Bhatia
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, India
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Durgapal P, Joshi PP, Gupta A, Gupta A, Kishore S, Singh A. Granulomatous inflammation still fooling surgeons. Trop Doct 2019; 49:252-253. [PMID: 30885055 DOI: 10.1177/0049475519836364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Prashant Durgapal
- 1 Assistant Professor, All India Institute of Medical Sciences, Rishikesh, India
| | - Prashant P Joshi
- 1 Assistant Professor, All India Institute of Medical Sciences, Rishikesh, India
| | - Ashish Gupta
- 1 Assistant Professor, All India Institute of Medical Sciences, Rishikesh, India
| | - Amit Gupta
- 2 Additional Professor, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
| | - Sanjeev Kishore
- 3 Professor, Department of Pathology, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
| | - Ashok Singh
- 4 Assistant Professor, Department of Pathology, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
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Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, Dhandania VK, Madhu SV, Rao PV, Geetha L, Subashini R, Unnikrishnan R, Shukla DK, Kaur T, Mohan V, Das AK. Authors' response. Indian J Med Res 2016; 143:374-5. [PMID: 27241655 PMCID: PMC4892088 DOI: 10.4103/0971-5916.182632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rajendra Pradeepa
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mohan Deepa
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Prashant P Joshi
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, India
| | | | - Sri Venkata Madhu
- Department of Medicine, University College of Medical Sciences & GTB Hospital, Delhi, India
| | - Paturi Vishnupriya Rao
- Department of Endocrinology & Metabolism, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Loganathan Geetha
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Radhakrishnan Subashini
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Unnikrishnan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Deepak Kumar Shukla
- Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Tanvir Kaur
- Division of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
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Joshi PP. Cardiovascular risk factors and mortality in Bangladesh. Indian Heart J 2016; 68:433. [PMID: 27316511 PMCID: PMC4911445 DOI: 10.1016/j.ihj.2016.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 04/19/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Prashant P Joshi
- Department of Medicine, Indira Gandhi Govt. Medical College, Nagpur 440018, Maharashtra, India.
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Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, Dhandania VK, Madhu SV, Rao PV, Geetha L, Subashini R, Unnikrishnan R, Shukla DK, Kaur T, Mohan V, Das AK. Prevalence of generalized & abdominal obesity in urban & rural India--the ICMR-INDIAB Study (Phase-I) [ICMR- NDIAB-3]. Indian J Med Res 2016; 142:139-50. [PMID: 26354211 PMCID: PMC4613435 DOI: 10.4103/0971-5916.164234] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND & OBJECTIVES Overweight and obesity are rapidly increasing in countries like India. This study was aimed at determining the prevalence of generalized, abdominal and combined obesity in urban and rural India. METHODS Phase I of the ICMR-INDIAB study was conducted in a representative population of three States [Tamil Nadu (TN), Maharashtra (MH) and Jharkhand (JH)] and one Union Territory (UT)[Chandigarh (CH)] of India. A stratified multi-stage sampling design was adopted and individuals ≥ 20 yr of age were included. WHO Asia Pacific guidelines were used to define overweight [body mass index (BMI) ≥ 23 kg/m [2] but < 25 kg/m [2]], generalized obesity (GO, BMI ≥ 25 kg/m [2], abdominal obesity (AO, waist circumference ≥ 90 cm for men and ≥ 80 cm for women) and combined obesity (CO, GO plus AO). Of the 14,277 participants, 13,800 subjects (response rate, 96.7%) were included for the analysis (urban: n = 4,063; rural: n = 9737). RESULTS The prevalence of GO was 24.6, 16.6, 11.8 and 31.3 per cent among residents of TN, MH, JH and CH, while the prevalence of AO was 26.6, 18.7, 16.9 and 36.1 per cent, respectively. CO was present in 19.3, 13.0, 9.8 and 26.6 per cent of the TN, MH, JH and CH population. The prevalence of GO, AO and CO were significantly higher among urban residents compared to rural residents in all the four regions studied. The prevalence of overweight was 15.2, 11.3, 7.8 and 15.9 per cent among residents of TN, MH, JH and CH, respectively. Multiple logistic regression analysis showed that female gender, hypertension, diabetes, higher socio-economic status, physical inactivity and urban residence were significantly associated with GO, AO and CO in all the four regions studied. Age was significantly associated with AO and CO, but not with GO. INTERPRETATION & CONCLUSIONS Prevalence of AO as well as of GO were high in India. Extrapolated to the whole country, 135, 153 and 107 million individuals will have GO, AO and CO, respectively. However, these figures have been estimated from three States and one UT of India and the results may be viewed in this light.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialities Centre, Chennai, India
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Abstract
GlySH-surfactant herbicide (GlySH), one of the most commonly used herbicides worldwide, has been considered as minimally toxic to humans. However, clinical toxicologists occasionally encounter cases of severe systemic toxicity. The US Environmental Protection Agency (EPA) states that 'GlySH' is of relatively low oral and acute dermal toxicity. It does not have anticholinesterase effect and no organophosphate-like central nervous system (CNS) effects. The clinical features range from skin and throat irritation to hypotension and death. Severe GlySH-surfactant poisoning is manifested by gastroenteritis, respiratory disturbances, altered mental status, hypotension refractory to the treatment, renal failure, and shock.[1] GlySH intoxication has a case fatality rate 3.2-29.3%. Pulmonary toxicity and renal toxicity seem to be responsible for mortality. Metabolic acidosis, abnormal chest X-ray, arrhythmias, and elevated serum creatinine levels are useful prognostic factors for predicting GlySH mortality.[2] There is no antidote and the mainstay of treatment for systemic toxicity is decontamination and aggressive supportive therapy. We report a case of acute pulmonary edema, which is a rare but severe manifestation of oral GlySH poisoning, where patient survived with aggressive supportive therapy.
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Affiliation(s)
- Darshana Sudip Thakur
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Rajashree Khot
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - P P Joshi
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Madhuri Pandharipande
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Keshav Nagpure
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
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Zodpey SP, Shrikhande SN, Negandhi HN, Ughade SN, Joshi PP. Risk factors for acute myocardial infarction in central India: a case-control study. Indian J Community Med 2015; 40:19-26. [PMID: 25657508 PMCID: PMC4317976 DOI: 10.4103/0970-0218.149265] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 03/05/2013] [Indexed: 01/18/2023] Open
Abstract
Background: Atherosclerosis is a multi-factorial disease involving the interplay of genetic and environmental factors. Studies highlighting the public health importance of risk factors like chronic infections causing acute myocardial infarction (AMI) in the Indian context are scarce. This study was undertaken to study the association of socio-demographic and life-style factors with acute myocardial infarction in central India. Materials and Methods: The cases and controls were group-matched for age, gender, and socio-economic status. A blinded research associate administered the study questionnaire. We performed an unconditional multiple logistic regression analysis. Results: The case-control study included 265 cases of AMI and 265 controls. The results of final model of logistic regression analysis for risk factors of AMI included 11 risk factors at α = 0.05. They were waist hip ratio, body mass index, stress at home in last 1 year, hypertension, family history of CHD, past history of gingival sepsis, tobacco smoking, raised total serum cholesterol, Chlamydia pneumoniae, Helicobacter pylori and raised C-reactive protein. Conclusion: The findings confirm the role of conventional risk factors for cardiac disease and highlight need for research into the association between chronic infections with AMI.
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Affiliation(s)
- Sanjay P Zodpey
- Director-Public Health Education, Public Health Foundation of India, New Delhi, India
| | - Sunanda N Shrikhande
- Department of Microbiology, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Himanshu N Negandhi
- Public Health Foundation of India, Indian Institute of Public Health, New Delhi, India
| | - Suresh N Ughade
- Department of Preventive and Social Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Prashant P Joshi
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
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Unnikrishnan R, Anjana RM, Deepa M, Pradeepa R, Joshi SR, Bhansali A, Dhandania VK, Joshi PP, Madhu SV, Rao PV, Lakshmy R, Jayashri R, Velmurugan K, Nirmal E, Subashini R, Vijayachandrika V, Kaur T, Shukla DK, Das AK, Mohan V. Glycemic control among individuals with self-reported diabetes in India--the ICMR-INDIAB Study. Diabetes Technol Ther 2014; 16:596-603. [PMID: 25101698 PMCID: PMC4135327 DOI: 10.1089/dia.2014.0018] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIMS This study estimated the levels of glycemic control among subjects with self-reported diabetes in urban and rural areas of four regions in India. RESEARCH DESIGN AND METHODS Phase I of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) Study was conducted in a representative population of three states of India (Tamil Nadu, Maharashtra, and Jharkhand) and one Union Territory (Chandigarh) and covering a population of 213 million people. Using a stratified multistage sampling design, individuals ≥20 years of age were recruited. Glycemic control among subjects with self-reported diabetes was assessed by measurement of glycated hemoglobin (HbA1c), estimated by the Variant™ II Turbo method (Bio-Rad, Hercules, CA). RESULTS Among the 14,277 participants in Phase I of INDIAB, there were 480 subjects with self-reported diabetes (254 urban and 226 rural). The mean HbA1c levels were highest in Chandigarh (9.1±2.3%), followed by Tamil Nadu (8.2±2.0%), Jharkhand (8.2±2.4%), and Maharashtra (8.0±2.1%). Good glycemic control (HbA1c <7%) was observed only in 31.1% of urban and 30.8% of rural subjects. Only 22.4% of urban and 15.4% of rural subjects had reported having checked their HbA1c in the past year. Multiple logistic regression analysis revealed younger age, duration of diabetes, insulin use, and high triglyceride levels to be significantly associated with poor glycemic control. CONCLUSIONS The level of glycemic control among subjects with self-reported diabetes in India is poor. Urgent action is needed to remedy the situation.
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Affiliation(s)
- Ranjit Unnikrishnan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Ranjit Mohan Anjana
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Mohan Deepa
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Rajendra Pradeepa
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Prashant P. Joshi
- Department of Medicine, Indira Gandhi Government Medical College, Nagpur, India
| | - Sri Venkata Madhu
- Department of Medicine, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Paturi Vishnupriya Rao
- Department of Endocrinology & Metabolism, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ramakrishnan Lakshmy
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Ramamurthy Jayashri
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Kaliaperumal Velmurugan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Elangovan Nirmal
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Radhakrishnan Subashini
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Venkataraman Vijayachandrika
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Tanvir Kaur
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Deepak Kumar Shukla
- Department of Non Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Post-Graduate Medical Education & Research, Puducherry, India
| | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, India
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Anjana RM, Pradeepa R, Das AK, Deepa M, Bhansali A, Joshi SR, Joshi PP, Dhandhania VK, Rao PV, Sudha V, Subashini R, Unnikrishnan R, Madhu SV, Kaur T, Mohan V, Shukla DK. Physical activity and inactivity patterns in India - results from the ICMR-INDIAB study (Phase-1) [ICMR-INDIAB-5]. Int J Behav Nutr Phys Act 2014; 11:26. [PMID: 24571915 PMCID: PMC3974063 DOI: 10.1186/1479-5868-11-26] [Citation(s) in RCA: 166] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/21/2014] [Indexed: 12/01/2022] Open
Abstract
Background The rising prevalence of diabetes and obesity in India can be attributed, at least in part, to increasing levels of physical inactivity. However, there has been no nationwide survey in India on physical activity levels involving both the urban and rural areas in whole states of India. The aim of the present study was to assess physical activity patterns across India - as part of the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Methods Phase 1 of the ICMR-INDIAB study was conducted in four regions of India (Tamilnadu, Maharashtra, Jharkhand and Chandigarh representing the south, west, east and north of India respectively) with a combined population of 213 million people. Physical activity was assessed using the Global Physical Activity Questionnaire (GPAQ) in 14227 individuals aged ≥ 20 years [urban- 4,173; rural- 10,054], selected from the above regions using a stratified multistage design. Results Of the 14227 individuals studied, 54.4% (n = 7737) were inactive (males: 41.7%), while 31.9% (n = 4537) (males: 58.3%) were active and 13.7% (n = 1953) (males: 61.3%) were highly active. Subjects were more inactive in urban, compared to rural, areas (65.0% vs. 50.0%; p < 0.001). Males were significantly more active than females (p < 0.001). Subjects in all four regions spent more active minutes at work than in the commuting and recreation domains. Absence of recreational activity was reported by 88.4%, 94.8%, 91.3% and 93.1% of the subjects in Chandigarh, Jharkhand, Maharashtra and Tamilnadu respectively. The percentage of individuals with no recreational activity increased with age (Trend χ2: 199.1, p < 0.001). Conclusions The study shows that a large percentage of people in India are inactive with fewer than 10% engaging in recreational physical activity. Therefore, urgent steps need to be initiated to promote physical activity to stem the twin epidemics of diabetes and obesity in India.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viswanathan Mohan
- Department of Epidemiology & Diabetology, Madras Diabetes Research Foundation & Dr,Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control & IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, India.
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Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, Bhansali A, Joshi SR, Joshi PP, Yajnik CS, Dhandhania VK, Nath LM, Das AK, Rao PV, Madhu SV, Shukla DK, Kaur T, Priya M, Nirmal E, Parvathi SJ, Subhashini S, Subashini R, Ali MK, Mohan V. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011; 54:3022-7. [PMID: 21959957 DOI: 10.1007/s00125-011-2291-5] [Citation(s) in RCA: 457] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/28/2011] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS This study reports the results of the first phase of a national study to determine the prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in India. METHODS A total of 363 primary sampling units (188 urban, 175 rural), in three states (Tamilnadu, Maharashtra and Jharkhand) and one union territory (Chandigarh) of India were sampled using a stratified multistage sampling design to survey individuals aged ≥ 20 years. The prevalence rates of diabetes and prediabetes were assessed by measurement of fasting and 2 h post glucose load capillary blood glucose. RESULTS Of the 16,607 individuals selected for the study, 14,277 (86%) participated, of whom 13,055 gave blood samples. The weighted prevalence of diabetes (both known and newly diagnosed) was 10.4% in Tamilnadu, 8.4% in Maharashtra, 5.3% in Jharkhand, and 13.6% in Chandigarh. The prevalences of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) were 8.3%, 12.8%, 8.1% and 14.6% respectively. Multiple logistic regression analysis showed that age, male sex, family history of diabetes, urban residence, abdominal obesity, generalised obesity, hypertension and income status were significantly associated with diabetes. Significant risk factors for prediabetes were age, family history of diabetes, abdominal obesity, hypertension and income status. CONCLUSIONS/INTERPRETATIONS We estimate that, in 2011, Maharashtra will have 6 million individuals with diabetes and 9.2 million with prediabetes, Tamilnadu will have 4.8 million with diabetes and 3.9 million with prediabetes, Jharkhand will have 0.96 million with diabetes and 1.5 million with prediabetes, and Chandigarh will have 0.12 million with diabetes and 0.13 million with prediabetes. Projections for the whole of India would be 62.4 million people with diabetes and 77.2 million people with prediabetes.
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Affiliation(s)
- R M Anjana
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, WHO Collaborating Centre for Noncommunicable Diseases Prevention and Control, IDF Centre for Education, 4, Conran Smith Road, Gopalapuram, Chennai 600 086, India
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Abstract
The present study was undertaken to clarify whether methanolic extract of Tridax procumbens prevents liver fibrosis in rat. The hepatic fibrosis was induced by 28 days of bile duct ligation in rats. The 4-week treatment with Tridex procumbens reduced the serum aspartate aminotransferase (U L⁻¹), glutamate pyruvate transaminase (U L⁻¹), alkaline phosphatase (IU L⁻¹), lactate dehydrogenase (IU L⁻¹), total bilirubin (mg dL⁻¹), direct bilirubin (mg dL⁻¹) and hydroxyproline (mg gm⁻¹) content in liver and improved the histological appearance of liver section. The results of this study led us to conclude that T. procumbens can reduce the degree of hepatocellular damage and may become antifibrotic agent for liver fibrosis.
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Affiliation(s)
- P P Joshi
- Department of Pharmacology, R.C. Patel College of Pharmacy, Shirpur, Maharastra, India
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Jeemon P, Prabhakaran D, Huffman MD, Ramakrishnan L, Goenka S, Thankappan KR, Mohan V, Joshi PP, Mohan BVM, Ahmed F, Ramanathan M, Ahuja R, Chaturvedi V, Lloyd-Jones DM, Reddy KS. Distribution of 10-year and lifetime predicted risk for cardiovascular disease in the Indian Sentinel Surveillance Study population (cross-sectional survey results). BMJ Open 2011; 1:e000068. [PMID: 22021747 PMCID: PMC3191418 DOI: 10.1136/bmjopen-2011-000068] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/25/2011] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) prevention guidelines recommend lifetime risk stratification for primary prevention of CVD, but no such risk stratification has been performed in India to date. METHODS The authors estimated short-term and lifetime predicted CVD risk among 10,054 disease-free, adult Indians in the 20-69-year age group who participated in a nationwide risk factor surveillance study. The study population was then stratified into high short-term (≥ 10% 10-year risk or diabetes), low short-term (<10%)/high lifetime and low short-term/low lifetime CVD risk groups. RESULTS The mean age (SD) of the study population (men=63%) was 40.8 ± 10.9 years. High short-term risk for coronary heart disease was prevalent in more than one-fifth of the population (23.5%, 95% CI 22.7 to 24.4). Nearly half of individuals with low short-term predicted risk (48.2%, 95% CI 47.1 to 49.3) had a high predicted lifetime risk for CVD. While the proportion of individuals with all optimal risk factors was 15.3% (95% CI 14.6% to 16.0%), it was 20.6% (95% CI 18.7% to 22.6%) and 8.8% (95% CI 7.7% to 10.5%) in the highest and lowest educational groups, respectively. CONCLUSION Approximately one in two men and three in four women in India had low short-term predicted risks for CVD in this national study, based on aggregate risk factor burden. However, two in three men and one in two women had high lifetime predicted risks for CVD, highlighting a key limitation of short-term risk stratification.
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Affiliation(s)
- Panniyammakal Jeemon
- Centre for Chronic Disease Control, New Delhi, India
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Public Health Foundation of India, New Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
- Center of Excellence, Center for Cardio-metabolic Risk Reduction in South Asia, New Delhi, India
| | - Mark D Huffman
- Centre for Chronic Disease Control, New Delhi, India
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | | - K R Thankappan
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala
| | - V Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | | | - B V M Mohan
- Narayana Hrudayalaya Institute of Medical Sciences, Bangalore, India
| | - F Ahmed
- KPC Medical College, Jadavpur, Kolkata, India
| | | | - R Ahuja
- King George Medical College, Lucknow, India
| | | | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Holay MP, Patil PS, Joshi PP, Dube AM, Suryawanshi SD, Waradkar P. Association of impaired cognitive functions with cardiovascular risk factors in elderly Indian population. J Assoc Physicians India 2011; 59:91-94. [PMID: 21751643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The prevalence of dementia is projected to rise dramatically in future with increasing life expectancy. Though dementia itself is not treatable in majority of cases, modification of co-morbid medical conditions may influence onset and rate of decline of cognitive functions. OBJECTIVE To determine the prevalence of dementia in elderly by assessing cognitive function and to assess the association of cardiovascular risk factors with cognitive functions. STUDY DESIGN Cross sectional analytical study. PARTICIPANTS 400 consecutive elderly subjects > 65 years attending Geriatric OPD, Dept. of Medicine, Indira Gandhi Government Medical College, Nagpur, were recruited and assessed for cognitive functions by applying Mini Mental Status examination Score (MMSE). Relationships between cardiovascular risk factors and impaired cognitive score were determined. RESULTS Prevalence of impaired cognitive function (MMSE Score < 25) was 33.25% (133 cases), while that of dementia (MMSE < 23) was 3.25 % (13 cases) in this elderly population. Impaired cognitive function was higher in those with low education and low socioeconomic status, (p = < 0.001). Increasing age, Female gender, alcohol intake and high cholesterol were found to be independently associated with impaired cognitive score in multiple logistic regression (p = < 0.001). Hypertension, diabetes mellitus, smoking and obesity were not associated with impaired cognitive score. CONCLUSION Prevalence of cognitive impairment rises significantly as the age advances and is associated with alcohol intake and high cholesterol.
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Affiliation(s)
- M P Holay
- Dept. of Medicine, Indira Gandhi Govt. Medical College, Nagpur
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Jeemon P, Prabhakaran D, Mohan V, Thankappan KR, Joshi PP, Ahmed F, Chaturvedi V, Reddy KS. Double burden of underweight and overweight among children (10-19 years of age) of employees working in Indian industrial units. Natl Med J India 2009; 22:172-176. [PMID: 20131480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Along with the existing problem of underweight, overweight in children is increasing in the developing world. However, there is little information on its magnitude and pattern in the Indian context. We aimed to study the pattern and correlates of overweight in Indian children and adolescents. METHODS A total of 3750 children in the age group of 10-19 years, who were family members of randomly selected employees from 10 different industrial sites in India, were surveyed using an interviewer-administered questionnaire. RESULTS The prevalence of underweight was highest in peri-urban areas (30.2% and 53.2% according to Indian and international criteria, respectively). In urban and highly urban areas, the prevalence of underweight was 14.1% and 9.8%, respectively, according to the Indian criteria, and 27.1% and 19.2%, respectively, according to international criteria. The proportion of overweight children was highest in the highly urban category (19.1% and 13.4% according to Indian and international criteria, respectively). The level of urbanization (OR 3.1 and 4.7 for overweight in urban and highly urban areas, respectively, compared with peri-urban areas, p < 0.001), physical activity (OR 0.4, p < 0.001, in children with physical activity score > or = 75th percentile compared with a score < or = 75th percentile) and frequency of meals outside the home (OR 12, p < 0.001, if > 25% weekly meals taken outside the home compared with < 25% of weekly meals outside home) were significant predictors of overweight. CONCLUSION There is a double burden of underweight and overweight among Indian children and adolescents.
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Affiliation(s)
- P Jeemon
- Initiative for Cardiovascular Health Research in the Developing Countries, C1/52, Second Floor, Safdarjang Development Area, New Delhi 110016, India
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Prabhakaran D, Jeemon P, Goenka S, Lakshmy R, Thankappan K, Ahmed F, Joshi PP, Mohan BM, Meera R, Das MS, Ahuja RC, Saran RK, Chaturvedi V, Reddy KS. Impact of a Worksite Intervention Program on Cardiovascular Risk Factors. J Am Coll Cardiol 2009; 53:1718-28. [DOI: 10.1016/j.jacc.2008.12.062] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 12/09/2008] [Accepted: 12/22/2008] [Indexed: 10/20/2022]
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Powar RM, Shegokar VR, Joshi PP, Dani VS, Tankhiwale NS, Truc P, Jannin J, Bhargava A. Retraction Notice. Indian J Med Microbiol 2009. [DOI: 10.1016/s0255-0857(21)01755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mohan V, Mathur P, Deepa R, Deepa M, Shukla DK, Menon GR, Anand K, Desai NG, Joshi PP, Mahanta J, Thankappan KR, Shah B. Urban rural differences in prevalence of self-reported diabetes in India--the WHO-ICMR Indian NCD risk factor surveillance. Diabetes Res Clin Pract 2008; 80:159-68. [PMID: 18237817 DOI: 10.1016/j.diabres.2007.11.018] [Citation(s) in RCA: 183] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 11/21/2007] [Indexed: 12/14/2022]
Abstract
Recent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national non-communicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from peri-urban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p<0.001). Urban residents with abdominal obesity and sedentary activity had the highest prevalence of self-reported diabetes (11.3%) while rural residents without abdominal obesity performing vigorous activity had the lowest prevalence (0.7%). In conclusion, this nation-wide NCD risk factor surveillance study shows that the prevalence of self-reported diabetes is higher in urban, intermediate in peri-urban and lowest in rural areas. Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in this study.
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Affiliation(s)
- Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr.Mohan's Diabetes Specialities Centre, 4 Conran Smith Road, Gopalapuram, Chennai 600086, India.
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Joshi PP. Is waist to height ratio a better and more practical measure of obesity to assess cardiovascular or diabetes risk in indians? J Assoc Physicians India 2008; 56:202-204. [PMID: 18700281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
Humans have innate immunity against Trypanosoma brucei brucei that is known to involve apolipoprotein L-I (APOL1). Recently, a case of T. evansi infection in a human was identified in India. We investigated whether the APOL1 pathway was involved in this occurrence. The serum of the infected patient was found to have no trypanolytic activity, and the finding was linked to the lack of APOL1, which was due to frameshift mutations in both APOL1 alleles. Trypanolytic activity was restored by the addition of recombinant APOL1. The lack of APOL1 explained the patient's infection with T. evansi.
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Affiliation(s)
- Benoit Vanhollebeke
- Laboratory of Molecular Parasitology, Institut de Biologie et de Médecine Moléculaires, Université Libre de Bruxelles, Gosselies, Belgium
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Shegokar VR, Powar RM, Joshi PP, Bhargava A, Dani VS, Katti R, Zare VR, Khanande VD, Jannin J, Truc P. Short report: Human trypanosomiasis caused by Trypanosoma evansi in a village in India: preliminary serologic survey of the local population. Am J Trop Med Hyg 2006; 75:869-70. [PMID: 17123979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
After discovery of the first recorded case of human infection with Trypanosoma evansi, serologic screening of 1,806 persons from the village of origin of the patient in India was performed using the card agglutination test for trypanosomiasis and T. evansi. A total of 410 (22.7%) people were positive by whole blood, but only 81 were confirmed positive by serum. However, no trypanosomes were detected in the blood of 60 people who were positive at a high serum dilution. The results probably indicate frequent exposure of the human population to T. evansi in the study area, which suggests frequent vector transmission of parasites to humans. Although T. evansi is not infective for humans, a follow-up of seropositive persons is required to observe the evolution of human infection with this parasite.
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Affiliation(s)
- Vijay R Shegokar
- Department of Microbiology, Government Medical College, Nagpur, India
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Joshi PP, Chaudhari A, Shegokar VR, Powar RM, Dani VS, Somalwar AM, Jannin J, Truc P. Treatment and follow-up of the first case of human trypanosomiasis caused by Trypanosoma evansi in India. Trans R Soc Trop Med Hyg 2006; 100:989-91. [PMID: 16455122 DOI: 10.1016/j.trstmh.2005.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 11/04/2005] [Accepted: 11/04/2005] [Indexed: 10/25/2022] Open
Abstract
The first reported human case of trypanosomiasis caused by Trypanosoma evansi was treated using suramin. Patient follow-up indicates that the drug and specific regimen used were well tolerated. Clinical, serological and parasitological investigations at 6 months indicate complete cure of the patient. Suramin should be considered in the treatment of other cases of human T. evansi infection, if they occur.
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Affiliation(s)
- P P Joshi
- Department of Medicine, Government Medical College, Nagpur, India
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Joshi PP, Kulkarni MV, Yu BK, Smith KR, Norton DL, van Veelen W, Höppener JWM, Franklin DS. Simultaneous downregulation of CDK inhibitors p18(Ink4c) and p27(Kip1) is required for MEN2A-RET-mediated mitogenesis. Oncogene 2006; 26:554-70. [PMID: 16953232 DOI: 10.1038/sj.onc.1209811] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Multiple endocrine neoplasia type 2A (MEN2A) is predisposed by mutations in the RET proto-oncogene. Low expression of the cyclin-dependent kinase inhibitor (CDKI) p27(Kip1) is present in thyroid tumors, and recent evidence demonstrates p27 downregulation by the active RET mutant, RET/PTC1, found in papillary thyroid carcinoma. This implicates decreased p27 activity as an important event during thyroid tumorigenesis. However, p27(-/-) mice develop MEN-like tumors only in combination with loss of another CDKI, p18(Ink4c). This suggests that p18 and p27 functionally collaborate in suppression of tumorigenesis, that loss of both is critical in the development of MEN tumors and that both p18 and p27 are regulated by RET. We report that induction of the constitutively active MEN2A-specific RET mutant, RET2A(C634R), correlates with reduced p18/p27, and elevated cyclin D protein levels, leading to increased CDK activity, increased pRb phosphorylation and proliferation under growth arrest conditions. Mechanistically, RET2A represses p18/p27 mRNA levels while elevating cyclin D1 mRNA levels. RET2A expression also correlates with decreased p27 protein stability. RET2A-mediated regulation of p18 and p27, but not of cyclins D1 and D2, requires functional mitogen-activated protein kinase signaling. Additionally, RET2A-dependent p18 repression is required and sufficient to increase cell proliferation. Perhaps most significantly, MEN2A adrenal tumors also display these changes in cell cycle expression profile, demonstrating the biological relevance of our cell culture studies. Our results demonstrate for the first time that RET2A regulates p18, and suggest that loss of not only p27 but also of p18 expression is a key step in MEN tumorigenesis.
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Affiliation(s)
- P P Joshi
- Department of Biological Sciences, Purdue Cancer Center, Purdue University, West Lafayette, IN, USA
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Reddy KS, Prabhakaran D, Chaturvedi V, Jeemon P, Thankappan KR, Ramakrishnan L, Mohan BVM, Pandav CS, Ahmed FU, Joshi PP, Meera R, Amin RB, Ahuja RC, Das MS, Jaison TM. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bull World Health Organ 2006; 84:461-9. [PMID: 16799730 PMCID: PMC2627369 DOI: 10.2471/blt.05.027037] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To establish a surveillance network for cardiovascular diseases (CVD) risk factors in industrial settings and estimate the risk factor burden using standardized tools. METHODS We conducted a baseline cross-sectional survey (as part of a CVD surveillance programme) of industrial populations from 10 companies across India, situated in close proximity to medical colleges that served as study centres. The study subjects were employees (selected by age and sex stratified random sampling) and their family members. Information on behavioural, clinical and biochemical determinants was obtained through standardized methods (questionnaires, clinical measurements and biochemical analysis). Data collation and analyses were done at the national coordinating centre. FINDINGS We report the prevalence of CVD risk factors among individuals aged 20-69 years (n = 19 973 for the questionnaire survey, n = 10 442 for biochemical investigations); mean age was 40 years. The overall prevalence of most risk factors was high, with 50.9% of men and 51.9% of women being overweight, central obesity was observed among 30.9% of men and 32.8% of women, and 40.2% of men and 14.9% of women reported current tobacco use. Self-reported prevalence of diabetes (5.3%) and hypertension (10.9%) was lower than when measured clinically and biochemically (10.1% and 27.7%, respectively). There was marked heterogeneity in the prevalence of risk factors among the study centres. CONCLUSION There is a high burden of CVD risk factors among industrial populations across India. The surveillance system can be used as a model for replication in India as well as other developing countries.
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Affiliation(s)
- K S Reddy
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Powar RM, Shegokar VR, Joshi PP, Dani VS, Tankhiwale NS, Truc P, Jannin J, Bhargava A. A rare case of human trypanosomiasis caused by Trypanosoma Evansi. Indian J Med Microbiol 2006; 24:72-4. [PMID: 16505565 DOI: 10.4103/0255-0857.19904] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Human trypanosoma infections like the ones seen in Africa and South America are unknown in India. The only exception in literature is of two documented cases of a self-limiting febrile illness, being attributed to Trypanosoma lewisi like parasites. We are reporting an unusual case of trypanosomiasis from the rural parts of Chandrapur district in Maharashtra. An adult male farmhand who used to practice veterinary medicine also, presented with history of febrile episodes on and off since five months and drowsiness before admission to this Institute. Though routine blood and other investigations were within normal limits, the peripheral smear showed a large number of trypanosomes which morphologically resembled the species Trypanosoma evansi, the aetiological agent of surra - a form of animal trypanosomiasis. A battery of assays covering the spectrum of parasitology, serology, and molecular biology confirmed the infecting parasite to be T. evansi. Failure to demonstrate the central nervous system (CNS) involvement, as evidenced by the absence of parasite in cerebrospinal fluid (CSF) advocated the use of suramin - the drug of choice in early stage African trypanosomiasis without any CNS involvement. Suramin achieved cure in our patient. The case is being reported because of its unique nature as the patient was not immunocompromised and showed infestation with a parasite which normally does not affect human beings.
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Affiliation(s)
- R M Powar
- Department of Microbiology, Government Medical College, Nagpur - 440 003, Maharashtra, India.
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Joshi PP, Shegokar VR, Powar RM, Herder S, Katti R, Salkar HR, Dani VS, Bhargava A, Jannin J, Truc P. Human trypanosomiasis caused by Trypanosoma evansi in India: the first case report. Am J Trop Med Hyg 2005; 73:491-5. [PMID: 16172469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
We report an Indian farmer who had fluctuating trypanosome parasitemia associated with febrile episodes for five months. Morphologic examination of the parasites indicated the presence of large numbers of trypanosomes belonging to the species Trypanosoma evansi, which is normally a causative agent of animal trypanosomiasis known as surra. Basic clinical and biologic examinations are described, using several assays, including parasitologic, serologic, and molecular biologic tests, all of which confirmed the infecting species as T. evansi. Analysis of cerebrospinal fluid indicated no invasion of the central nervous system (CNS) by trypanosomes. Suramin, a drug used exclusively for treatment of early-stage human African trypanosomiasis with no CNS involvement, effected apparent cure in the patient. This is the first case reported of human infection due to Trypanosoma evansi, which was probably caused by transmission of blood from an infected animal.
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Affiliation(s)
- Prashant P Joshi
- Department of Medicine, Government Medical College, Nagpur, India
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Abstract
Selective serotonin reuptake inhibitors (SSRIs) can cause the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is associated with hyponatraemia without oedema. We report the case of a patient who developed acute-onset hyponatraemia that progressed rapidly to serious neurological dysfunction shortly after the introduction of citalopram. All SSRIs including citalopram should be used with care in the elderly. The water and electrolyte balance should be monitored carefully during SSRI therapy.
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Holay MP, Paunikar NP, Joshi PP, Sahasrabhojney VS, Tankhiwale SR. Effect of passive smoking on endothelial function in: healthy adults. J Assoc Physicians India 2004; 52:114-7. [PMID: 15656044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Active smoking predisposes to atherosclerotic vascular disease but recent evidence that inhalation of environmental tobacco smoke (passive smoking) may also have deleterious cardiovascular effects, has enormous public health implications. Endothelial dysfunction is an important early feature of atherogenic process, which may occur due to passive smoking. OBJECTIVE To assess the effect of passive smoking on endothelial function (measured by flow-mediated dilatation, a marker of endothelium-dependent arterial dilatation) and compare it with non-smokers. STUDY DESIGN Case control study. SETTING Out-Patient Department of Medicine, Government Medical College, Nagpur. PARTICIPANTS Seventy-five young, healthy, male adults between 15-30 years age were studied. There were three groups: (a) Non smokers (n = 25) (b) Passive smokers (n= 25) and (c) Active smokers (n = 25). Subjects with diabetes mellitus, hypertension and ischemic heart disease were excluded. Lipid profile was measured in all. Endothelial function was tested non-invasively by using high frequency linear vascular probe on brachial artery. Resting brachial artery lumen, flow at rest and after hyperemia, flow-mediated dilatation and nitroglycerine-induced dilatation were measured. RESULTS The mean brachial artery lumen dilatation and flow at rest were similar in all the three groups. Flow-mediated dilatation (FMD%, a marker of endothelium-dependent dilatation and endothelial function) was significantly higher in non-smokers than passive smokers (8.9 +/- 4.8 Vs 5 +/- 2.3, p < 0.01) and also as compared with active smokers (8.9 +/- 4.8 Vs 6.6 +/- 2.2, p < 0.05). Nitroglycerine-induced dilatation, (a marker of endothelium-independent dilatation ) was similar in all the three groups. Serum lipids (mean cholesterol, LDL, and mean LDL/HDL ratio) were statistically significantly higher in passive and active smokers as compared with non-smokers (p < 0.05). CONCLUSION Like active smoking, passive smoking was also associated with impaired endothelial function, (a key early event in atherogenesis) and altered lipid profile, in healthy young adults.
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Affiliation(s)
- M P Holay
- Department of Medicine Indira Gandhi Medical College, Nagpur
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Kirpekar VC, Deshpande SM, Joshi PP. Reversible myocarditis in a patient receiving clozapine. Indian Heart J 2001; 53:779-81. [PMID: 11838936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Myocarditis is a rare and potentially life-threatening complication of clozapine. We report the case of a 2 6-year-old patient who developed reversible myocarditis during treatment with clozapine for chronic resistant schizophrenia. The patient recovered rapidly on withdrawal of clozapine and with supportive management.
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Joshi PP. Patient compliance with drug therapy. J Assoc Physicians India 1999; 47:655-6. [PMID: 10999182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Joshi PP, Mohanan CJ, Sengupta SP, Salkar RG. Factors precipitating congestive heart failure--role of patient non-compliance. J Assoc Physicians India 1999; 47:294-5. [PMID: 10999123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE This study was aimed to identify systematically the precipitating factors causing decompensation of heart failure and subsequent hospitalisation. We specially assessed the role of patient non-compliance with therapy as an important precipitating factor for heart failure, since it has not been systematically studied previously in an Indian setting where rheumatic heart disease is common. METHODS In this cross-sectional analytical study, 125 cases of congestive heart failure hospitalized in Government Medical College, Nagpur, were studied. All the patients were thoroughly evaluated and investigated to identify the precipitating factors for heart failure. A patient was categorized as being non-compliant with therapy if he/she was consuming less than 80% prescribed drugs (assessed by pill count) or was non-compliant with dietary advice (assessed by an interviewer-administered questionnaire). RESULTS Rheumatic heart disease was the commonest underlying heart disease (52.8%) followed by ischemic and/or hypertensive heart disease (27.2%). The most common precipitating factor was patient non-compliance with diet or drug therapy (49.6%) followed by arrhythmias (16.8%), uncontrolled hypertension (14.4%), infective endocarditis (13.6%), anemia (14.4%) and infections (11.2%). CONCLUSION The results emphasize the importance of patient non-compliance with prescribed therapy as a leading precipitating factor for congestive heart failure in an Indian setting, which can be prevented by appropriate cost-effective strategies aimed to improve patient compliance.
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Affiliation(s)
- P P Joshi
- Clinical Epidemiology Unit, Govt Medical College, Nagpur
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Holay MP, Jalgaonkar PD, Joshi PP, Bisne VV, Fusey SM. Rheumatic pulmonary valve disease. J Assoc Physicians India 1998; 46:495-6. [PMID: 11273310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Joshi PP, Usendi N. Gender differences in the risk profile, treatment and mortality of acute myocardial infarction. J Clin Epidemiol 1998. [DOI: 10.1016/s0895-4356(98)90012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Joshi PP, Deshmukh P, Salkar R. Efficacy of intravenous magnesium sulphate in supraventricular tachyarrhythmias. J Clin Epidemiol 1998. [DOI: 10.1016/s0895-4356(98)90011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mahorkar U, Joshi PP, Tikhile AR. Pleuro-pericardial communication: demonstration by pleural contrast echocardiography. Indian Heart J 1997; 49:204-6. [PMID: 9231561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- U Mahorkar
- Avanti Institute of Cardiology, Dhantoli & Govt. Medical College, Nagpur
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Joshi PP, Nair M. Risk factors for hemorrhagic stroke. J Clin Epidemiol 1997. [DOI: 10.1016/s0895-4356(97)87176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Joshi PP. Prevalence of lipid and glycaemic abnormalities in hypertensive patients: a retrospective survey. Indian Heart J 1996; 48:739. [PMID: 9062035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Joshi PP, Salkar RG, Heller RF. Determinants of poor blood pressure control in urban hypertensives of central India. J Hum Hypertens 1996; 10:299-303. [PMID: 8817403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the factors responsible for poor blood pressure (BP) control among patients started on treatment for hypertension, with the hypothesis that patient non-compliance would be an important determinant. DESIGN Patients attending the Cardiology Clinic of the Government Medical College, Nagpur with hypertension for the first time were followed for 3 months and labelled as uncontrolled, if at end of this time the mean of two measures of diastolic blood pressure (DBP) was > 95 mm Hg, despite apparently adequate anti-hypertensive drugs. STUDY FACTORS Compliance (measured by pill count), life stress (measured by life event score), smoking and alcohol intake and demographic variables (measured by an interviewer-administered questionnaire), and body mass index (BMI). RESULTS Of 156 subjects recruited, 139 (89%) completed follow-up of 3 months, of whom 45 (32%) had uncontrolled hypertension (DBP > 95 mm Hg) at the end of follow-up. There was no statistically significant difference in the baseline characteristics of subjects who completed follow-up as compared with those lost to follow-up. The mean age of the patients was 55 years and male to female ratio was 1.5:1. Sixty-one per cent of the uncontrolled hypertensives were non-compliant by pill count (taking < 80% of drugs) as compared to 21% of the controlled hypertensives (odds ratio, OR = 6.1, 95% Cl = 3.9-12.6; P < 0.0001). There was no statistically significant difference in the mean age, mean BMI, sex distribution, alcohol intake, cigarette smoking rates, educational level, occupational or marital status between controlled and uncontrolled hypertensives. The median life event score (LES) was significantly higher in uncontrolled than in controlled hypertensives 4 vs 1.5 (P < 0.00001). Multiple logistic regression analysis found non-compliance and LES to be statistically significant independent predictors of uncontrolled hypertension. CONCLUSION Patient non-compliance with drugs and life stress may help explain poor BP control in patients on treatment for hypertension in this setting.
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Affiliation(s)
- P P Joshi
- Clinical Epidemiology Unit, Government Medical College, Nagpur, India
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Joshi PP, Dixit A, Salkar R. Effect of obesity on the response to antihypertensive drugs. J Clin Epidemiol 1996. [DOI: 10.1016/0895-4356(96)89168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Joshi PP. Magnesium in cardiovascular therapy. J Assoc Physicians India 1995; 43:724-5. [PMID: 8773022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Joshi PP, Deshmukh PK, Salkar RG. Efficacy of intravenous magnesium sulphate in supraventricular tachyarrhythmias. J Assoc Physicians India 1995; 43:529-31. [PMID: 8772970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study was conducted to evaluate the clinical efficacy of intravenous (i.v.) magnesium sulphate 2 gm bolus in sustained supraventricular tachycardia (SVT) and atrial flutter-fibrillation with fast ventricular rate of more than 160/min (AF-FVR) and to compare it with i.v. verapamil 5 mg. In this randomised controlled trial, 68 cases of SVT and 86 cases of AF-FVR were studied. Patients with evidence of renal dysfunction and systolic blood pressure less then 90 mm Hg were excluded. Response was considered when the heart rate fell to less than 100/min. In SVT, 33.3% (11 out of 33) responded to magnesium sulphate which was significantly less than verapamil (23 out of 35, 65.7%) p = 0.007. Similarly, in AF-FVR, response was more with verapamil (25 out of 45, 55.6%) than magnesium sulphate (8 out of 41, 19.5%) p < 0.0001. Response to magnesium sulphate was better in patients with IHD. There were no significant side effects, except flushing and sense of warmth with i.v. magnesium sulphate. Serum magnesium rose significantly after i.v. magnesium bolus. Though magnesium sulphate is a weaker antiarrhythmic drug than verapamil, further studies are needed to identify subgroups of supraventricular tachyarrhythmias which would respond to magnesium sulphate.
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Affiliation(s)
- P P Joshi
- Dept of Medicine, Govt. Medical College, Nagpur
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Joshi PP. Incidence of coronary artery disease in asymptomatic uncomplicated essential hypertension patients. J Assoc Physicians India 1994; 42:845. [PMID: 7876068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Joshi PP. Is a hypertensive always a hypertensive? J Assoc Physicians India 1993; 41:765. [PMID: 8005952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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