European Journal of Cardiovascular Medicine

Background: The Calcium Score (CS) is a pre clinical index of atherosclerosis and the prediction of cardiovascular risk is more accurate if CS is included. Current guidelines recommend the use of CS scoring for cardiovascular risk with intermediate-risk patients but there is not established the role of CS in patient with low risk factors.Objective: To define the prognostic significance of CS in smokers (SMO) or not smokers (NSMO)without symptoms. Diabetic patients were excluded in the first analysis.Methods: we’ve studied, in primary prevention, 32 not diabetic patients, 16 females and 16 males, range 60 ± 15 years old, with a metabolic syndrome based on the Third Adult Treatment Panel ATP III criteria of the National Cholesterol Education Program. Patients underwent to a heart coronary CT angiography (HCCT), a not invasive procedure. We have classified the patients into two groups: SMO (a pack of cigarettes for 10 years minimum) and NSMO (In NSMO category are included adults patients that have never smoked or have smoked not more than 100 cigarettes during their entire life). The SMO displayed have higher CS (94 (3;301.5) vs 0 (0;10.2); p<0.001), in comparison with NSMO. Accordingly, the associations between CS and cigarette smoking was still maintained after adjustment for age (rs 0.317; p<0.05). Finally, multiple regression analysis showed that smoke was the variable that best predicted the CST variance (R2 0.131; ®-standardised coefficient 0.362; p<0.05) . Results: CS gravity and extension have been elevated in smokers and the statistical correlation has been highly significant. CS is related to age, epicardial fat and smoke. Stepwise analysis demonstrated that smoke parameter is independent to age and epicardial fat. Conclusions: CS score offers a direct measurement of subclinical coronary pathology. Our study demonstrates that smokers have an elevated CS and the CS, in our opinion, is absolutely useful for the screening of coronary disease in asymptomatic smokers.

Clopidogrel and Aspirin are widely used antiplatelet agents in the prevention and treatment of isch- emic heart disease (IHD). Many patients have been noticed with recurrence of major ischemic events, due to resistance of these drugs. Different platelet function tests can be used to evaluate the de- gree of achieved platelet inhibition in patients treated with clopidogrel. The objective of this study was to determine frequency of clopidogrel resistance in patients of ischemic heart disease. Seventy one patients of IHD were selected from out-patient department of Punjab Institute of Cardiology Lahore. Platelet aggregation studies were performed on Diamed Impact R. Clopidogrel response as- say was performed with DiaAdin(ADP 110µmol/L). Chi-square test was applied to measure statistical significance. Resistance to Clopidogrel was observed in 17% (12 out of 71). Clopidogrel resistance was significantly associated with female gender (p=0.046). In our study no statistically significant as- sociation was observed between clopidogrel resistance and risk factors like diabetes mellitus, family history ischemic heart disease, hypertension and smoking. We concluded that resistance to Clopido- grel therapy is seen in significant number of patients and female patients are at high risk of develop- ing the resistance to clopidogrel therapy. These patients can be identified by performing platelet aggregation studies on Impact R.

Allergic rhinitis is the most common atopic disorder seen in the outpatient clinic. Montelukast, is a novel medication, is an antagonist to the leukotriene receptor. The aim of this work was to identify the improvement in the severity of symptoms of child with AR treated with Montelukast. A cross-sectional study was conducted among fifty-patients with a chronic cough and (sneezing, nasal congestion, rhinorrhea, and postnasal drip) at least eight weeks using Montelukast between the periods of January 2019 to March 2019. By using the symptom severity score for AR, that calculated. Data including (age, gender, associated disease, exacerbation factors, and classical therapy). The dose of 10-mg Montelukast once daily was prescribed. On follow-up, after four-weeks, compliance was ensured and then the symptom severity score was recorded again. Most of patients aged above 40 years. Males to females ratio was 1:1.5. Most of patients (40, 80%) lived in urban regions. There was a reduction of the symptoms associated with RA after treatment with Montelukast. Exacerbation factors was as following, dust was found in 80%, food 40%, exercise 64%, psychological 50%, and smoking 48%. SSS was declined after therapy significantly (P=0.05). Patients using showed improvement of symptoms, pain was relieved from 82%, exhaustion 80%, vomiting 92%, sleep disturbance in 80%, affecting daily life in 88%, and syncope 96%. In conclusion, the common symptoms of AR are improvement in response to Montelukast. The improvement in the symptom severity score was maximum in sneezing-nasal congestion- rhinorrhea and least in postnasal drip

Introduction: Most epidemiological data concerning low back pain (LBP) are related to developed and industrialized countries but little information about LBP in the general population in developing and low-income countries. Back pain affects 60-80% of people at some time in their lives. Acute low back pain is one of the most common reasons for adults to see a family physician. Although most patients recover quickly with minimal treatment, proper evaluation is imperative to identify rare case of serious underlying pathology. Aim of the study: The aim of the study is to evaluate the different causes of low back pain, occupational and risk factors, association with age and sex of the patient and their life styles. Materials and Methods: The present study is a retrospective study of 300 patients of low back pain between the age group of 31-70 years of both sexes who were admitted and treated at Dept. of Forensic Medicine, Kushtia Medical College Hospital, Kushtia, Bangladesh from January 2020 to December 2020. The information was collected from the patients regarding their occupation, education, obesity, smoking, tuberculosis, diabetes, alcohol consumption, osteoporosis, Osteoarthritis and history of trauma. The provisional diagnosis of cases was done and confirmed radiologically. A proforma was prepared and the patient’s age, sex, duration of symptoms, place of living and the cause for low back pain was noted. A neurological examination of the lower limbs was performed. Results: The author tabulated 300 patients of low back pain into four categories according to age and noted the number of cases in each group. The highest number of cases (124) is observed in the age group of 31-40 years (41%) and the lowest number of cases (45) is observed in the age group of 51-60 years (15%). All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus, smoking, alcohol and medication history), subjected to a rigorous clinical examination and a battery of investigations. In 300 cases of LBP studied, the most common cause for back pain was disc prolapse (44%). The next common causes were lumbar spondylosis, spondylolisthesis and lumbar spinal stenosis (17%, 10% & 10% respectively).The study found association between low back pain and various factors. Prevention is the best strategy for avoiding low back pain but is realistically hard to practice because the problem of low back pain has many environmental and intrinsic risk factors. Conclusion: Low back pain affects a large proportion of the population and is difficult to diagnose. Physicians must accept the diagnostic ambiguity that often accompanies the condition. Identification of etiological and risk factors, cause for back pain and type of occupation and instituting preventive measures, as well as rehabilitation of patients can lead to a meaningful reduction in the incidence of debilitating back pain.

Background & Aim: Smoking represents a very significant epigenetic risk factor for not only the development of periodontitis, but also influences its severity and reduces treatment response. An anti- oxidant, resveratrol (trihydroxystilbene) blocks neutrophil recruitment and oxidative bursts, lessen oral inflammatory load, thereby reducing clinical manifestations of periodontitis

Introduction: We done the Comparative Assessment of Motor Nerve Conduction Velocity among Non-Diabetic, Diabetic Non-Smoker and Sub Groups of Diabetic Smoker the diagnosis of diabetic peripheral europathy is mainly based on its characteristic symptoms, but mostly these symptoms develop at any stage of neuropathic impairment or they may not develop at all. Materials and Methods: Smoking index is used to find the exposure of smoking on body quantitatively and is calculated by multiplying the average number of cigarettes smoked per day in last seven days with the duration of smoking in years

Introduction: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by altered bowel habits and recurrent abdominal pain. The Rome III criteria are the main mainstay for its diagnosis. The reliability on any biochemical markers is reduced provided all warning signs have been excluded. The aim of our study was to assess the prevalence of IBS among medical students in our region (Western Punjab) and to investigate the lifestyle, sociodemographic and clinical factors associated with IBS. Materials and Methods: A cross sectional study was conducted among Indian medical students. Participants (first- to fifth year medical students from different courses) were invited to complete an anonymous questionnaire addressing social, demographic and clinical characteristics. 456 medical students were recruited in this study. Rome III criteria were used to identify patients with IBS. This questionnaire was used to gather baseline information like the family history of irritable bowel syndrome, socio-demographic data, history of chronic disease, previous diagnosis of IBS, daily sleep hours, smoking, food habits etc. Results: This study included 268 male medical students and 188 were female medical students. Approximately two third of the (69.2%) were in the age group 21 to 24 years and 26.3% had the age between 18 and 20 year and very few among age group of 24-27 years. IBS was diagnosed among 276 out of 456 participants based on Rome III Criteria. The profiles for symptoms were characterized by constipation predominant (IBS-C) (45.6%), diarrhea predominant (IBS-D) (44.7%), and others as mixed type (9.7%). The prevalence of IBS was reported as 72.3% among the female medical students studying at various medical colleges in Punjab and 53.7% among male students. Conclusion: In conclusion, 60.5% of medical students, in this study, met the Rome III criteria for IBS diagnosis. Risk factors for IBS among them included depression, anxiety, low fruits and vegetables intake, taking caffeine and any chronic medication’s intake

Background: H. pylori is the most common human bacterial pathogen that colonizes the gastric epithelium especially in those habitual Qat chewers; it influence can absorption of glucose which is also abnormal in DM patients, its common infection in diabetic patients who have inadequate metabolic control, this study was conducted to reveal the prevalence of H. pylori among T2DM and non-DM patients and potential risk factors. Methods: A cross-sectional study was conducted in the department of medicine, a tertiary care hospital in India, and there were 250 patients who included in this study. Data were collected through structural intervals questionnaire and sampling information. Results: The overall prevalence of H. pylori among diabetics was 29.2%. There was no significant association between H. pylori infections and diabetes (P> 0.05), most of the patients were 46-60 year age group, with male predominance (76.7%) H. pylori infections were not significantly associated with the smoking, hypertension, dyslipidemia and obesity. H. pylori infection increased in longer duration of diabetes and the increase in HbA1c level. Conclusion: Positive H. pylori DM patients should update their sugar level values and control the disease. Further research is highly recommended on relationship between H. pylori infections and diabetes

Periodontitis is a multifactorial disease causing inflammatory destruction of supporting structures of the dentition and eventually leading to its loss. This study was designed to evaluate common risk factors for periodontitis and acute coronary syndrome in the study population and demonstrate the systemic impact of periodontitis on the occurrence of acute coronary syndrome. A total of 160 patients (35 female and 125 male) were enrolled in the study. Considering the age range, the largest group of patients (118 patients) was between 55 and 65 years, which accounted for 73.8% of the total study population. There were 35 patients (21.9%) in the age group of 45 to 54 years, while the youngest age group of 35 to 44 years had as many as seven patients. Medical history and physical examination, including periodontal status, were performed. API, PD, CAL, and CPITN were evaluated. Common risk factors for periodontitis and acute coronary syndrome were assessed. The study assessed risk factors such as hypertension, diabetes, dyslipidemia, general health, smoking, height, weight, and hip circumference. In light of the above-described etiopathogenesis of atherosclerotic disease and its association with periodontal disease, it is important to emphasize preventing and treating periodontitis, especially in patients in the so-called high-risk group for cardiovascular disease. Dentists’ introduction of an appropriate prophylactic and therapeutic plan may constitute both primary and secondary prevention of cardiovascular diseases

Background:  In India smoking and tobacco dipping are major health problems and one of the largest preventable causes of disease and premature death. Nicotine has been reported to improve attention, learning, reaction time (RT), problem solving, and stimulus evaluation and discrimination. Previous research has established that cholinergic systems are important for cognitive functioning and nicotine is a potent cholinergic stimulant that affects many central nervous system (CNS) pathways, including the auditory pathway. It is a measure of function of sensory­ motor association and performance of an individual. It involves stimulus processing, decision making, and response programming. Material and Methods: This is a Prospective, observational, comparative study was conducted in the Departments of Physiology at Index Medical College. Audio-visual reaction time – Measurement of reaction time is a simple test which is measured by ‘audiovisual reaction time apparatus’ (Anand agency, Pune). Reaction time is a commonly used parameter for measuring implicit learning. In measurement of reaction time subject was asked to respond by pressing the button as soon as he had received the stimulus in the form of sound or light. The apparatus provides both auditory (low and high pitched sounds) and visual (red and green) stimuli. The arrangement consists of a source of stimulus, response key and the time recording device. The response is given by the subject by pressing a key with his index finger. Results: In the present study, in age groups ART values were significantly different (Graph-1) in all three groups, ART and VRT values increase in control, smokers and dipping tobacco users as age advances. As regards ART values, age group 31-40 years differs significantly from age group 11-20 years and 21-30 years (p<0.05), similarly age group 41-50 years differs significantly from age groups 11-20 years, 21-30 years and 31-40 years. As regards, VRT values age groups differ from each other but age group 41-50 years differ significantly from age group 11-20 years and age group 21-30 years.  Conclusion: Significant difference was also observed after smoking and after 12 hours of abstinence in study group subjects. This indicated increased reaction time required for integration process in CNS and delayed conduction in reflex arc after abstinence. Thus, the evidence presented in this article supports that temporary abstinence from nicotine has adverse effect on reaction time which may force them to smoke again. Health education and nicotine replacement therapy may help them to achieve the ultimate goal of complete cessation from smoking.

Background:  Asthma attack is the most common respiratory symptom observed and is of great concern. Throughout the world asthma cases are increasing during pregnancy. The major issue is that the control levels of asthma is changing during pregnancy so the management is a little difficult during pregnancy. Objective: The present study was undertaken to observe the prevalence of asthma and respiratory symptoms during pregnancy. Materials and methods: 40 pregnant women attending OPD in the hospital were part of the study after obtaining the written informed consent. Confidentiality of the data was maintained. Willing pregnant women were included in the study. Pregnant women with any other complications severe were excluded from the study. Respiratory symptoms were examined during the general physical examination by an expert physician. Results: The age group of the participants ranges from 22-30 years. 25% of individuals have asthma. 37.5% of individuals have wheeze without cold, 15% of individuals have nasal allergies. 27.5% have shortness of breath. 5% of individuals have a history of smoking. 15% of individuals are currently under the medication for asthma. Conclusion: The present study results explained that wheezing without cold and shortness of breath are the most common respiratory symptoms during pregnancy. Further detailed studies with a higher sample size are recommended to understand better the respiratory symptoms during pregnancy

Introduction Asthma is a long-term condition affecting children and adults. The air passages in the lungs become narrow due to inflammation and tightening of the muscles around the small airways. This causes asthma symptoms such as cough, wheeze, and shortness of breath and chest tightness. It can be difficult to coordinate breathing using an inhaler, especially for children and during emergency situations. The assessment of asthma control has become pivotal in the management of asthma. However, several surveys in developed nations have shown that the majority of patients with asthma do not enjoy adequate asthma control. This is not because asthma control is unrealistic and not achievable; the multicentre, multinational study of asthma management, the Gaining Optimal Asthma control (GOAL) study, has shown that well-controlled asthma is achievable in the majority of patients.  Materials and Methods: This is a descriptive and cross-sectional study to assess the levels of asthma control among adult patients attending Tertiary Care Teaching Center. The study used those (physician-diagnosed asthma patients) participants who volunteered. There is a causality department where patients presenting with acute asthma attack are managed. Complicated cases of asthma including status asthmaticus are managed in the high dependency unit. Results: Prevalence of bronchial asthma in adolescents was 13.1% (n = 110) of which 10.2% had episodes in the past 1 year. Prevalence was higher among males (6.23%) compared to females (3.94%). About 79.1% of total asthmatics were newly diagnosed cases. Prevalence was significantly higher among those having pets at home (P < 0.001), belonging to higher socioeconomic status (P = 0.021), using smoke producing fuel at home (firewood/cow dung/kerosene; P = 0.021), and with history of smoking among family members (P = 0.027). Among current asthmatics, 71.8% reported cold/rhinitis (51.3% in March–May duration), 59.1% nocturnal dry cough, 48.2% sleep disturbances, and 42.7% speech disturbances in the past 1 year. Discussion: In our study we found, there is significant increase in weight, BSA, BMI, where as significant decrease in DBP of diabetic group compared to Non-Diabetics & there is significant increase in FBS, HbA1C levels of Diabetic group significant decrease in LH levels of Diabetics compared to Non-Diabetics. However T3 levels of Diabetic and Non-Diabetic group were almost same, where as T4, Oestradiol and progesterone levels of diabetic group non-significantly increased and FSH and TSH levels non-significantly decreased in Diabetics. There is frequent co-existence of thyroid dysfunction and diabetes mellitus among post menopausal diabetic women. Conclusion: We estimated the global prevalence of ACO based on population-based studies and found that 2.0% of the general population is affected. However, the prevalence of ACO depends on its diagnostic criteria. Therefore, there is a vital need to better define the ACO diagnostic criteria, management and treatment. It is worth noting that the limitations of the present study include lack of studies in some region of the world and small number of studies included in the subgroup analyses

Background: Peptic ulcers are the defects found in the gastric or duodenal mucosa and extend through the muscularis mucosa. Approximately 4 million people are affected by peptic ulcer disease every year.Material andMethods. This prospective observational study was conducted at the Postgraduate Department of General Surgery, Government Medical College, Srinagar (a tertiary care center) over a period of two years from October 2020 to October 2022.The aim of this study was to evaluate the accuracy of PULP (Peptic Ulcer Perforation) scoring system in predicting postoperative morbidity and mortality in patients operated for peptic ulcer perforation in our hospital.Results. 40 patients formed our study group. Maximum number of patients affected were in the younger age group, with median age of 25 years with male predominance (97.5%). Smoking was present in 67.5%. Serum creatinine was raised (>1.47mg/dl) in 22.5% patients. 90% patients were categorized as low risk according to PULP Score. Mortality was 5%, with PULP score of 11 each.  Conclusions.The prognostic predictors present in the PULP score are readily identified before surgery. The PULP score helps in accurate and early identification of high - risk patients with perforated peptic ulcer, and therefore assist in risk stratification and triage

Introduction: An ectopic pregnancy occurs when the developing blastocyst implants either outside the uterus i.e fallopian tube (interstitial, ampullary, isthmic, fimbrial), Ovary and abdominal cavity or in an abnormal position within the uterus i.e cornual, cervical. Around 98.3% of ectopic pregnancies occur in the fallopian tubes. Visualization of an intrauterine sac, with or without fetal cardiac activity, is often adequate to exclude ectopic pregnancy. The treatment modality also has evolved from radical surgery, conservative surgery to medical and expectant management. Laparoscopy is now recommended approach in surgical management of ectopic pregnancy.Materials and Methods: This is a prospective observational study conducted in Department of Obstetrics and Gynaecology from 2020 to 2022 where 118 cases were studied. Detailed history was taken for all cases with special reference to risk factors like smoking, PID, abortions, previous ectopic, IUD use, sterilization, D & C, IVF and LSCS followed by clinical examination. Routine and other relevant investigations were done including (UPT, CBC, ICTC, HCV, HbSAg, USG (TVS) and serum β-HCG and managed according to the condition of patient either medical, surgical or both. Data regarding intraoperative finding confirming site of ectopic pregnancy, ruptured or unruptured, operative techniques including salpingectomy, salpingo ophorectomy, cornual repair or hysterectomy and blood product transfusion were collected. Patients were followed up till discharge or death and the outcome were analysed. Results: Maximum numbers of cases, 45 cases (38.1%) were in the age group between 26 to 30 years. Among all cases, 24 cases (20.3%) had history of previous abortions, 22 cases (18.6%) had history of PID, 14 cases (11.9%) had undergone D & C earlier, 8 cases (6.8%) had earlier tubal ligation, 5 cases (4.2%) had h/o IUCD insertion and 1 case (0.8%) had previous history of ectopic pregnancy. The classical triad of amenorrhea, abdomen pain and abnormal vaginal bleeding was seen in 52 cases (44.0%). The most common site of ectopic pregnancy site was fallopian tube, of which 96 cases (81.3%) were in amupulla, 14 cases (11.9%) were in isthmus and only 3 cases (2.5%) were in infundibulum. Only 2 cases (1.7%) had cornual pregnancy with gestational sac implanted in the non communicating horn of unicornuate uterus. Maximum number of ectopic pregnancy cases underwent surgery, with 98 cases (83.0%) had undergone  unilateral salpingectomy as the most common procedure whereas 15 cases (12.7 %) had undergone unilateral salpingophorectomy in cases with unhealthy ovary and ovarian pregnancy out of 113 cases of tubal ectopic pregnancy. Only 2 cases (1.7%) with cornual pregnancy had cornual resection and repair. Hysterectomy was adopted as surgical treatment in 2 cases (1.7%) only.Conclusion: Patients with risk of ectopic pregnancy like PID, IUCD implantation, previous ectopic pregnancy and patients with history of D & C should undergo routine USG in first trimester to locate the site of early pregnancy. We recommend follow up above cases of ectopic pregnancy and analyzing the effect of ectopic pregnancy on future fertility and pregnancy.

Background: From minor bursal or articular side irritation and tendonitis to severe degenerative rotator cuff arthropathy, rotator cuff illness includes a broad spectrum of pathology. Adults of all ages can develop rotator cuff disease, and other shoulder conditions must be checked out by a thorough medical history and physical examination1.  Objectives: 1. To identify significant predictors of the functional outcome of rotator cuff repair, such as age, sex, side, tear size, fixation techniques, smoking, and associated pathology. 2. To evaluated the functional outcome of arthroscopic repair of full-thickness rotator cuff tears. Material & Methods:  This prospective study done in the Department of Orthopaedics, MVJ Medical College and Research Hospital, Hoskote, from February 2022 to January 2023. We included the patients who have undergone Arthroscopic repair of Rotator cuff tear in the Department of Orthopaedics. The functional outcome was assessed by two scoring systems, UCLA and ASES. Results: The incidence of partial thickness tears was 11 out of 20 evaluated and full thickness tears noted in rest. Restriction of external rotation seen in 16 patients. Arm lift off was positive in 90% patients. Belly press was positive in 60 % patients. Jobes empty can test is positive in all the cases.   Conclusion: Arthroscopic rotator cuff repair offered good results and enabled the same reconstruction as with open technique and avoided its complications. Arthroscopic rotator cuff repair is technically demanding procedure that needs prerequisite skills as diagnostic shoulder arthroscopy, arthroscopic subacromial decompression, and arthroscopic knot tying. It has been observed adherence to strict post-operative physiotherapy is key for achieving full range of movement and pain free activities of daily living.

Background: Occupational pulmonary diseases are more widespread and more disabling than any other group of occupational disease. The lung with its extensive surface area, high blood flow and thin alveolar epithelium is an important site of contact with substance in environment. The inhalation of dust over periods of time leads to proliferation and fibrotic changes in lungs. The workers working in industries suffer from various types of air way diseases like pneumoconiosis, farmer’s lung, chronic bronchitis, pulmonary fibrosis and asthma. So, the present study was undertaken to study the effects of wood dust on respiratory functions of exposed workers. Materials and methods: The present study was a cross-sectional comparative study. Subjects of experimental and control groups were selected by inclusion and exclusion criteria. There were two groups of experimental subjects (sawmill (n=50) and carpet workers (n=50)), who were non smokers and exposed to industrial dusts. And the subjects of control group were age matched, working in office set up, non smokers and not exposed to industrial dusts (n=100). Their height, weight, age, sex, presence of any respiratory symptoms/diseases, history of smoking and duration of exposure to dusts were documented using a standard case history sheet. Ambient temperature was also recorded. Weight was recorded in kg and height was measured in cm without shoes while standing erect. Pulmonary function parameters were recorded using an electronic spirometer. Result: In our study we found significantly lower PEFR values in their study as compare to healthy individuals in their study which is comparable PEFR (6.8±1.38 Versus 9.33±1.35) in our study. Moreover, we found significant lower FEV1/FVC ratio in their study in wood workers which also comparable with our study showing significant lower FEV1/FVC (89.99±5.70 Versus 77.91±6.6) ratio. Furthermore, MVV significantly lower among wood workers same interpretation was carried by our study with significant lower MVV (77.05±5.8) as compare to healthy individuals (112±4.6). Conclusion: We conclude from this study that workers exposed to pine and fibre wood dust have more respiratory symptoms than control subjects and that such exposure increases the risk of airflow obstruction. So, we recommend that workers should learn to use protective facemasks at sites and use other measures to reduce dust flow into the environment. It is important to take account not only of dust concentration, particle size, and exposure time, but also of a variety of background and individual factors (e.g., specific sort of wood, wood dust related biohazards, or disease history), since they may also contribute significantly to the decreased efficiency of lung function.

Conclusion: Serum homocysteine, vitamin B12and folic acid are easily available investigations which may predict the severity and outcome of patient s    of acute ischemic stroke.

Background: The factors that determine acute exacerbations and hospitalization in COPD patients are poorly understood. Factors that have been studied as predictors of mortality and other outcomes include FEV1, blood gases, co-morbidity, chronic mucus hypersecretion (CMH), muscle weakness, poor nutritional status, low BMI, socioeconomic status and support, number of previous physician visits or hospital admissions, influenza vaccination, pneumococcal vaccination, pulmonary rehabilitation, inhaled corticosteroids and long-term oxygen therapy. Hyperglycaemia is associated with poor outcomes from pneumonia, myocardial infarction and stroke, but the effect of blood glucose on outcomes from acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has not been established. Recent UK guidelines do not comment on measurement or control of blood glucose in AECOPD. A study was therefore undertaken to determine the relationship between blood glucose concentrations, length of stay in hospital, and mortality in patients admitted with AECOPD. Materials and methods: This study was a prospective study in a tertiary care hospital over a period of 48 months. During the initial 24 months, the patients were recruited in the study and for the next 24 months all these patients were followed up systematically for stability of the disease or any adverse impact. Patients who had acute exacerbation of COPD during the initial entry period of 24 months were included in the study. The inclusion criteria were: (i) patients with a principal diagnosis of AECOPD; (ii) age over 50 years; (iii) current smokers or ex‑smokers with a history of smoking equivalent to at least 20 pack‑years; and (iv) surviving patients with stable COPD status on discharge.  Result: Of 115 COPD patients admitted for AECOPD, 54% had one or more readmission, and another 45% had two or more readmissions over a period of 2 years. There was a high prevalence of current or ex‑heavy smokers, associated co‑morbidity, underweight patients, low vaccination prevalence and use of domiciliary oxygen therapy among COPD patients. A total of 12% mortality was observed in the present study. Immediate failure rates after first exacerbation was observed to be 34.8%. Multivariate analysis showed that duration >20 years (OR = 0.43; 95% CI: 0.15‑0.91), use of Tiotropium (OR = 3.33; 95% CI: 2.16‑6.74) and use of co‑amoxiclav during first admission (OR = 3.48; 95% CI: 2.28‑6.84) were significantly associated with higher immediate failure rates.  Conclusion: it has been shown that half of all chronic obstructive pulmonary disease patients hospitalised with acute exacerbations died within 3 yrs. These findings may help clinicians with important information about the probable short- and long-term survival of these patients. Thus, low levels of serum albumin strongly predict poorer long-term outcome, and longer duration of disease and longer time elapsed since first hospitalisation appear as new mortality related independent factors. The authors believe that the current findings will provide clinicians with new insights, allowing them to implement more individualised treatment strategies by better predicting the life expectancy of chronic obstructive pulmonary disease patients.

Background: Wound Healing is the summation of a number of processes that follow injury. Despite immense advances in the technique of wound creation and closure, there continues to be an important percentage of patients undergoing abdominal operations, suffering from delayed wound healing and partial wound failure. The aim of this study is to assess the various factors influencing post laparotomy wound healing. To identify the pre-operative, operative and post operative risk factors in patients having poor wound healing. Material and Methods: All adult male and female patients undergoing laparotomy for various indications were included in the study. This descriptive, non-interventional case study was conducted in the Departments of General Surgery in Veer Surendra Sai institute of medical science and research burla sambalpur. (Minimum of 100 cases). Results: This prospective study was conducted in VIMSAR hospital, burla, sambalpur. A total of 100 patients undergoing laparotomies were studied .40 patients were found to have delayed wound healing. The strongest association for delayed healing was found to be wound infection, followed by smoking, chronic cough, poorly controlled diabetes and alcohol. Conclusions: The incidence of delayed healing was found to be higher in our study with increased incidence of wound infection. It was found that emergency laparotomies were associated with an increased incidence of wound infection and thereby delayed healing. Poor wound healing is also associated strongly with poor nutrition and uncontrolled diabetes. These factors should be taken into account and efforts have to be made to correct the risk factors pre or post-operatively.

Introduction: Squamous cell carcinomas comprise 90% of oral cancers, are usually preceded by premalignant lesion.  Oral cancers are approachable to visual inspection and there are chances for earlier detection in order to reduce morbidity and mortality. Screening asymptomatic individuals by systematic visual oral examinations to detect the disease has been shown to be feasible. Despite the ready accessibility of oral cavity, these malignancies are often detected at late stage due to ignorance in rural areas. Aims and objectives: The present study aimed to identify clinicopathological characteristics of patients with oral squamous cell carcinoma (OSCC) according to age, sex and risk factors, to analyse histological differentiation specific to tumour and grading [Broder’s grading]. Materials and methods: A total of 137 samples received in the department of pathology between July 2015- June2017, were studied. Clinical data including age, gender, site, size of tumour, risk factors like alcohol consumption, smoking, pan chewing had been recorded. Histopathological grading was determined using Broder’s grading system. Results: The mean age of incidence was 54.6 yrs. with male predominance. Out of 137samples the most common presentation was with fungating growth seen in 71(51.8%) patients. The most common site was tongue in 49 cases (35.7%) followed by buccal mucosa in 38 cases (27.7%).  Aetiology of smoking accounted for 131 cases (95.6%), alcohol consumption in 74 cases (54%), pan chewing among 69 cases (50.3%).  Moderately differentiated tumours were observed in 73 cases (53.3%), well differentiated carcinoma in 60 cases (43.8%), verrucous carcinoma identified in 4 cases (2.9%) patients. Conclusion: OSCC is frequently encountered in fourth to sixth decade of life with male predominance. Smoking and pan chewing were common risk factors. The most common histological subtype was moderately differentiated squamous cell carcinoma.

Introduction: Dialysis access procedures and complications represent a major cause of morbidity in CKD patients. Recent guidelines have encouraged a creation of AV fistula access in a CKD patient at least 6 months before first dialysis for proper maturation and to give time, if any secondary procedure is needed due to primary failure. Aggressive strategy should be taken for creation of AV Fistula to avoid sepsis and morbidity of temporary access. Objectives: To analysis various factors affecting the primary failure, secondary failure and primary patency of AV Fistula, complications of AV Fistula and its management. Methods: We evaluate the AV Fistula created in RGKMCH in Urology department in 5 years period from January 2017 to February 2022 (212 cases of AV Fistula, done by Radio- cephalic or Brachio- Cephalic end to side anastomosis). A fistula is adequate, if it provides a blood flow of at least 350 ml/min in 6 sessions of hemodialysis in one month. Various demographic factors (age, sex), clinical factors (diabetes, obesity, persistent low BP with Interstitial Nephritis, smoking), venous anatomy of upper limbs, arterial atherosclerosis are related with primary failure and complications. Results: Of 212 AV Fistulas, 178 fistulas developed for dialysis and 34 were primary failure. Primary failure rate was lower in patients aged less than 65 years, in 34 cases of primary failure 6 patients developed pseudoaneurysm and required emergency closure of AV fistula. In 178 cases, 38 patients had eventually secondary failure (mean time ~4 months after initiation of HD) and required a second procedure in upper arm (mainly Brachio- cephalic anastomosis and 12 cases required Permanent Dialysis Catheter insertion in IJV). Primary failure was higher in poorly controlled diabetics (random CBG > 200mg/ dl), in atherosclerotics, in low BP (SBP< 100) and in elderly females. Among 6 cases of pseudoaneurysm in the entire study, 4 were poorly controlled diabetics. The adequacy rate was not related with Serum albumin, Serum PTH, Surgeon, Serum Creatinine. Primary (28 out of 34) and secondary failure (22 out of 38) rate is significantly higher in forearm fistula than upper arm fistula, but complications like pseudoaneurysm (4 cases), serpentine aneurysm (4 cases), steal phenomenon (10 cases), gangrene of the limb (2 cases) are more common in upper arm fistula. The adequacy of forearm fistula is poorer in older women, diabetics and they need upper arm fistula to avoid primary failure, though complications are more common in upper arm fistula.  Conclusion: Success rate of AV Fistula is lower in certain subset of patients. To achieve best outcome, AV Fistula need to be constructed in upper arm in older, female, low BP, or in diabetics, though upper arm fistula has more complications like pseudoaneurysm, serpentine aneurysm, steal phenomenon, gangrene of limb.

Background: Over the past three decades, Transradial-Access (TRA) has revolutionized cardiac catheterization, demonstrating superior safety and outcomes compared to other access points. The European Society of Cardiology has now endorsed TRA as a viable alternative to traditional methods. Challenges during TRA can arise despite its success, making a comprehensive assessment of forearm artery anatomy essential. Forearm artery angiography (FA) has emerged as a valuable tool to improve procedural success and reduce complications. In this study, we retrospectively analyze the impact of FA on a diverse patient population, aiming to enhance TRA's effectiveness and safety in cardiac catheterization procedures in Bangladesh. Aim of the study: This study investigates the potential for enhanced success rates of Coronary Angiography and Percutaneous Coronary Intervention (PCI) by utilizing Standardized Forearm Angiography in a diverse patient population. Methods: This is a prospective comparative study, a total of 480 patients were enrolled and analyzed in this study. The study was conducted at the Department of Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh. It analyzed 480 consecutive patients who underwent Coronary Angiography (CA), with or without Percutaneous Coronary Intervention (PCI). The study spanned one year, from January 2022 to December 2022.  Result: In this prospective study, 480 patients were analyzed, and various characteristics of the study population were examined. The average age of patients was 71.4 years, 71% male and 29% female. The study focused on forearm artery access, with 54.17% having right forearm access and 45.83% left forearm access. The most common access type for left forearm artery access was the distal radial artery, while the proximal radial artery dominated right forearm access. Arterial hypertension was the most prevalent variable, followed by diabetes mellitus and active smoking. The most common clinical indication for medical procedures was "Suspected CAD or chronic coronary syndrome." Etiological factors leading to medical conditions were also analyzed, with "Failure to achieve arterial puncture or introduce arterial sheath" being the most common factor, followed by "Kinking" and "Atherosclerotic occlusion." Conclusion: The retrospective analysis showcased promising results, indicating that standardized forearm angiography may lead to enhanced success rates in coronary angiography and PCI among a diverse patient population. This non-invasive approach could offer improved diagnostic accuracy and procedural outcomes, warranting further investigation and consideration for broader clinical implementation.

Background: Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality all over the world. It causes about one-third of all deaths in people older than 35years. We carried out this study because there was no such study carried out in Andaman and Nicobar Island to ascertain the incidence of CAD and the risk factors which lead to CAD in Andaman and Nicobar population. The health sector in Andaman and Nicobar is developing. Due to the increasing load of CAD patients recently the Cath Lab was started as the ANIIMS Port Blair / GB Pant Port Blair is the only tertiary care hospital in the whole of Andaman and Nicobar Islands. To get a better insight into the disease prevalence and how to lower the risk factors. Material and methods: This cross-sectional study was done in a tertiary hospital in Port Blair to find out the prevalence of risk factors among patients with coronary artery disease. A total of 315 patients were screened based on a questionnaire, ECG (Electrocardiography) and laboratory investigations. Data was analysed in SPSS and Microsoft Excel and was presented as tables and graphs. There was significant observation based on age, clinical features, risk factors, ECG patterns and laboratory diagnosis. The result was conclusive of increased prevalence of risk factors among CAD patients which was also reported in various studies conducted in India and across the world.  Results: This study has estimated that the overall prevalence of Hypertension is 86.03%, Type 2 diabetes mellitus is 88.89%, Smoking is 55.87%, Hypercholesterolemia is 71.43%, Hypertriglyceridemia is 68.25%, Obesity is 65.40%, Stress is 61.9%, and Family history is 12.38%.  Conclusion: The present study demonstrates a high prevalence of CAD risk factors in the population of Port Blair, Andaman and Nicobar Islands. The study population reflects the rising trends of CAD in urban India. The incidence of CAD has increased further because of rapid urbanization and its accompanying effects like sedentary lifestyle changes, change in food habits, lack of outdoor activity. There should be an early detection of a risk factor to prevent morbidity and mortality in the community. Therefore, there is an immediate need to raise awareness among the general population regarding these risk factors, signs and symptoms of coronary heart disease promote the correct diet and physical activity, meditation,yoga and others and at the same time develop guidelines for screening and preventive therapeutic programs to identify and manage individuals at high risk for future CAD.  CAD can be prevented by dietary modification, changing lifestyle, decrease tobacco consumption and regular physical exercise. Screening and regular medical check-up of patient helps in early detection of CAD.

Introduction: Essential hypertension is a common circulatory system disease, which is affected by both genetic and environmental factors, and accounts for more than 40% of the cardiovascular disease total burden. Aim: To study 24 hour sodium and correlation to blood pressure and left ventricular hypertrophy in essential hypertension. Materials and methods: It is Hospital based Analytical Observational Cross-sectional study done in 100 patients comprised of hypertensive individuals presenting to Medicine op and patients admitted under the department who are fulfilling the inclusion and exclusion criteria.  Results: There was a strong positive correlation between Systolic BP , diastolic BP , MAP , duration of HTN (Years) and Urinary Sodium (mmol/L), and this correlation was statistically significant. There was a significant difference between the 2 groups in terms of urinary sodium(mmol/L), with the median Urinary Sodium (mmol/L) being highest in the LVHI. There was a significant difference between the various groups in terms of distribution of LVMI.There was a positive correlation between Systolic BP, Diastolic BP, MAP (mmHg) and LVMI (g/m2), and this correlation was statistically significant . There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2) (rho = 0.17, p = 0.084). There was no statistically significant correlation between BMI (Kg/m2) and LVMI (g/m2). Conclusions: Hypertension is one of the preventable causes of cardiovascular mortality. Hypertension can be prevented by modifiable risk factors such as low-salt diet, physical activity, blood sugar control, and smoking cessation.

Background: Coronary artery disease (CAD) imposes a substantial global burden, with millions affected. It remains a leading cause of morbidity and mortality, straining healthcare systems and necessitating proactive prevention and management efforts. Aims and Objectives: The present study aimed to study the prevalence OF Coronary Artery Disease among young Indian adults. Materials and Methods: The present study included 100 non cardiac patients attending the General Medicine OPD of Osmania General Hospital, Hyderabad. After obtaining consent, all the patients underwent detailed history taking, thorough clinical examination and necessary investigations. Data was collected in MS Excel, analyzed and presented as tables and figures. Results: Equal numbers of male and female patients were present in the study. The patients considered for the study fell into two (2) age groups, 20 – 30 years and 30 – 40 years. Both the age groups had almost equal no. of patients. Dyslipidemia was the most common risk factor in our study with 38% of the study population being dyslipidemic, followed by Hypertension (23%), Diabetes (21%), Sedentary Lifestyle (18%), Smoking (13%) and Obesity (9%). Family History of CAD was noted in 6% of study population. Conclusion: The current research highlights a notable occurrence of coronary artery disease (CAD) risk factors among the urban population in India. Consequently, urgent action is necessary to promote awareness about these risk factors, enabling proactive management of individuals at heightened risk for CAD in the future.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a global health concern associated with significant morbidity and mortality. Cardiac involvement, particularly left ventricular dysfunction (LVD), has gained attention as a common comorbidity in COPD patients. This prospective study aimed to elucidate the relationship between COPD and LVD, exploring incidence, predictors, clinical implications, and potential interventions. Methods: A cohort of 300 COPD patients, aged 40 years and older, underwent baseline assessments and regular follow-up visits over 24 months. Echocardiography, spirometry, and clinical data were collected. Predictors of LVD were identified using Cox proportional hazards models. Longitudinal changes in left ventricular ejection fraction (LVEF) and clinical outcomes were analyzed. Results: Over 24 months, LVD incidence increased from 0% at baseline to 28.3%. Age (HR 1.08 per year), current smoking (HR 2.15 vs. never smokers), and severe COPD (HR 3.20, GOLD Stage 4 vs. Stage 1) were significant predictors of LVD. LVEF declined progressively (from 57.8% to 52.2%). LVD was associated with higher hospitalizations (58.3% vs. 33.3%), mortality (25% vs. 8.3%), and exacerbations (133.3% vs. 62.5%) compared to non-LVD patients. Conclusion: This study reveals the dynamic relationship between COPD and LVD. Age, smoking, and disease severity were identified as predictors of LVD. The decline in LVEF over time and its impact on clinical outcomes underscore the clinical relevance of LVD in COPD patients. Comprehensive management

Early Repolarisation Pattern (ERP) is an umbrella term that refers to ST-Segment elevation in the absence of chest pain, terminal QRS slurring, or terminal QRS notch. In patients with angina or anginal equivalents with ERP pattern on ECG(Electrocardiograph), the diagnostic dilemma of ERP masking ischemia vs. non-cardiac chest pain cause can falter further workup. We present a case of a 40-year-old male with risk factors of smoking and dyslipidemia presented with complaints of typical anginal chest pain followed by CCS III(Chronic Coronary syndrome III) symptoms of angina and dyspnoea. On primary evaluation he was found to have an Early repolarisation pattern in ECG, despite having a normal 2D Echo and negative cardiac biomarkers, His CAG revealed single vessel disease in the Left Circumflex coronaries. After revascularisation, the patient showed both angiographic and symptomatic improvement.

Background: Cardiorenal syndrome type 1 (CRS1) represents a critical medical condition characterized by the rapid deterioration of cardiac function leading to acute kidney injury (AKI), posing significant healthcare challenges. Understanding this complex syndrome is crucial for improving patient care. Material and Methods: We conducted a one-year cross-sectional observational study at the Department of Medicine, Indira Gandhi Medical College, Shimla, enrolling consecutive patients with acute heart failure (AHF). We defined CRS1 as the rapid worsening of cardiac function leading to AKI and employed the Framingham Criteria for HF diagnosis. AKI was assessed using the AKIN classification. Various clinical, laboratory, and echocardiographic parameters were examined, and statistical analysis was performed. Results: Among the 92 AHF patients, 15 (16.3%) met the criteria for CRS1, while 77 (83.7%) did not experience kidney injury (NCRS1). Shortness of breath was the most common presenting symptom (93.47%). Patients with CRS1 had significantly lower total leukocyte counts (TLC) but no significant differences in other hematological or biochemical parameters. Dilated cardiomyopathy (DCMP) was a significant predisposing factor for CRS1, while other factors, including smoking, diabetes, and hypertension, did not contribute significantly. Medications for AHF management showed no significant impact on CRS1 development. Patients with CRS1 had higher mortality rates and longer hospital stays, with DCMP and Rheumatic Heart Disease (RHD) being major contributors to mortality. Conclusion: CRS1 is more prevalent in females and the elderly, presenting with shortness of breath and often triggered by infections. Lower TLC and DCMP are associated with CRS1 development. Smoking, diabetes, and hypertension appear unrelated to CRS1. Medications for AHF management showed no significant influence. DCMP emerges as a key underlying etiology, with CRS1 patients experiencing higher mortality rates and extended hospital stays, highlighting the need for tailored management strategies.

Objective: To evaluate the surgical outcomes of decompressive craniectomy in patients with cerebral venous sinus thrombosis (CSVT) at our institution. Methods: We conducted a retrospective analysis of 396 CSVT cases admitted to our institution. Among these, 45 (11.3%) underwent decompressive craniectomy. We assessed demographic data, clinical presentation, risk factors, Glasgow Coma Scale (GCS) scores upon presentation, and radiologic findings in relation to venous sinus and cerebral lobe involvement. Results: Of the 45 patients who underwent decompressive craniectomy, 26 (57.7%) were female and 19 (42.3%) were male. The mean age of incidence was 34 years, with a notable predominance in patients below 40 years (69%). The predominant presenting symptoms were headache (93.3%), altered sensorium (88.8%), focal motor deficit (60%), and convulsion (48%). Identified risk factors included chronic alcohol intake (31%), smoking (37%), postpartum status (30%), dehydration (51%), anemia (26%), homocystinemia (17.7%), and oral contraceptive pill usage (15%). In terms of GCS, 57.7% presented with scores between 8-12, while 22.2% had scores below 8. Radiologic findings revealed involvement of two or more sinuses in 21 patients. Specific sinus involvements were: superior sagittal (11 patients), sigmoid (7 patients), and transverse (6 patients). Regarding lobe involvement, the distribution was: parietooccipital (13 patients), frontal (10 patients), frontoparietal (14 patients), and temporoparietal (8 patients). Conclusion: Decompressive craniectomy serves as a crucial intervention in selected CSVT cases. Our study presents an institutional experience emphasizing demographics, clinical presentations, risk factors, and radiologic findings in patients undergoing this surgical intervention for CSVT.

Introduction: "Dilated Cardiomyopathy (DCMP)" is characterized by enlargement of one or both Ventricles and is accompanied by impaired LV function.. The causes can be primary (idiopathic) or secondary. Heart failure (HF) is a complex clinical syndrome resulting from the inability of the heart to pump resulting in inadequate metabolic demands of the tissues, or do so only with elevated filling pressures. Common symptoms are Dyspnea, fatigue, edema, syncope, and dysrhythmias. Heart Failure (HF) is predominantly a disorder of the elderly with rates increasing exponentially with time.  Aims and objectives: The objective of this study is to examine and record the clinical characteristics of individuals diagnosed with “Dilated Cardiomyopathy (DCMP”). Method: This retrospective observational study was conducted from September 2022 to August 2023 and involved 400 consecutive dilated cardiomyopathy patients. Patient examinations included clinical, ECG, radiography, and echocardiographic. Echocardiography criteria for impaired left ventricular systolic performance were ejection fraction below 45%, regional wall motion abnormalities, global hypokinesia of LV, heart chamber dilatation without valvular or congenital heart problems, and end-diastolic dimension above 3 cm per body surface area. Result: Smoking, alcoholism, Diabetes and hypertension were the leading risk factors in developing HF. Breathlessness(82.25%), swelling of the feet (50%) and palpitation (48%) were the most common symptoms observed in the patients. Edema of feet (50%), basal crepts (50.5%), raised and Jugular Venous Distention (JVD) (44.75%) were the leading signs in the patients. Chest X-ray (CXR) findings indicate that 62.75%  to 70% of the patients reported with increased Cardiothoracic ratio. ECG findings were : 59.5% had normal QRS axes, 25.5% had LAD, 15.00% had RAD. Common arrhythmias included sinus tachycardia (30.00%), ectopic beats (30.5%), AFib (21.75%), VT (8.00%), SVT (9.25%). LBBB was at 6.75%, RBBB at 3.00%. LA enlargement was 45.75%, RA 19.5%. LVH was present in 12.5% (left), 8.00% (right), and 3.00% (both). Patients with impaired cardiac function had an average EF% of 34.4 ± 6.03 (range: 20-45). LVDD and LVSD measures were 5.53 ± 0.74 cm and 4.46 ± 0.75 cm. Mitral regurgitation (MR) was present in 82%, TR in 14.00%. Wall motion abnormalities were widespread (97.25%). Pericardial effusion was found in 5.7% of patients. Moderate to severe Pulmonary artery hypertension was found in 19.5% Conclusion: The study has concluded that “dilated cardiomyopathy (DCM)” is mainly a disease of middle and elderly people with a higher prevalence among males. Pulmonary hypertension and very low ejection fraction was associated with adverse outcome.

Background: In the West, coronary heart disease, or CHD, is the main cause of mortality. Young people experiencing an acute myocardial infarction (AMI) is comparatively rare. Nevertheless, it remains a significant issue for both the patient and the attending physician. There are few studies of risk factors of coronary artery involvement in AMI in young adults, so the purpose of the present study is to identify the risk factors for acute myocardial infarction in rural India. Methods: This was an institute based Observational Cross Sectional Study, done at General Medicine Ward, Department of General Medicine, Burdwan Medical College and Hospital, West Bengal, India, from May 2020 to July 2021. Total 100 patients admitted with AMI during this period meeting the inclusion and exclusion criteria were included in this study. A Microsoft Excel spreadsheet containing the data was used for data entry, and SPSS (version 2710; SPSS Inc., Chicago, IL, USA) was used for analysis. Result: In the present study mean age of patients was 35.21 ±4.39 years, majority of patients belonged to age group of 36-40 years (56%). The mean BMI was 27.23 ±3.34 kg/m2. The most common presentation was chest pain (90%) followed by profuse sweating (65%), radiation to left shoulder/arm (45%), nausea/vomiting (40%), anxiety (38%), breathlessness (28%). Most common risk factor was smoking (85%) followed by hyperlipidemia (82%), family history of premature coronary artery disease (72%), hypertension (52%), sedentary lifestyle (42%), psychosocial stress (38%), obesity (16%) and diabetes mellitus (14%). Majority of the study subjects had more than 3 risk factors (64%), while 21% had 3 risk factors, 13% had two risk factors. Mean level of cardiac enzyme marker CKMB was 38.42 ±5.67 IU/L. Conclusion: Acute MI in young patients is becoming a rising problem in Indian subcontinent which is more common in men. Smoking was the most common risk factor of MI in them indicating atherosclerosis could be the commonest cause followed by dyslipidemia.

Background: Coronary artery disease (CAD) poses a significant global health challenge, particularly affecting the elderly population. This study aims to investigate the socio-demographic aspects of acute coronary syndrome (ACS) in elderly patients aged 75 years and above in the eastern region of India, specifically in Odisha. Methodology: The prospective observational study was conducted at the Outpatient Department (OPD) of VIMSAR Medical College and Hospital, Sambalpur, Odisha. A total of 182 consecutive patients aged over 75 years and diagnosed with ACS underwent routine coronary angiography/percutaneous coronary intervention. The study focused on documenting demographic and angiographic profiles, as well as the distribution of various coronary artery disease risk factors. Results: Male patients constituted the majority of the population, comprising more than two-thirds of the total. The average age of enrolled patients was 81.02 ± 3.35 years. Geographically, the majority of patients were from the district of Sambalpur (41.2%), followed by Sundargarh (26.9%), Debagarh (17.6%), and Bargarh (11.5%). The incidence of CAD was higher in urban/semiurban areas compared to rural areas. Smoking showed a significant association with the diagnosis of ST-elevation myocardial infarction (STEMI). Discussion: The study sheds light on regional variations in the socio-demographic profile of elderly patients with ACS in Odisha. The observed higher incidence in urban/semiurban areas emphasizes the impact of lifestyle on cardiovascular health. The significant association of smoking with STEMI aligns with broader literature, emphasizing the need for targeted interventions. Conclusion: The study provides essential insights into the socio-demographic factors associated with ACS in the elderly population of Odisha. Tailored interventions and public health strategies informed by these findings have the potential to reduce the burden of CAD in this vulnerable demographic. The study addresses a critical knowledge gap, contributing to the holistic management of CAD in the specific context of Odisha.

Background: As we all know that Stroke is becoming an important cause of disability and premature death in low-income and middle-income countries like India, affecting largely the poorer sections of the society driven by demographic changes and enhanced by the increasing prevalence of the key modifiable risk factors which impoverish their families further. Therefore, our study was planned to evaluate the risk factors and their prognostic value in patients of ischemic stroke in our setup? Research Question: What are the risk factors and their prognostic value in the patients of ischemic stroke?The setting of the study was at department of General Medicine, Government General Hospital, Government Medical College, Machilipatnam, Andhra Pradesh. A one-year observational study was conducted during the period from October 2022 to September 2023 on about 100 Ischemic Stroke cases admitted during the above period in the department of General Medicineby studying their socio-demographic profiles, associated risk factors, assessment of the degree of severity in association with risk factors, clinical course and outcome, etc. Results: Among the total study subjects 61% were male and 39% were female and it was observed that the distribution of the disease was more as age advances and it was also noticed that the severity of the disease was more among males when compared to females. Among all the study subjects 55% had hypertension followed by 45% had diabetes mellitus, 34% had history of smoking, 26% had history of regular alcohol intake, 23% had dyslipidemia, 13% had heart disease, 6% had hypercoagulable states,10% had history of TIA, 6% had history of migraine, 3% had history of OC pills usage and 2% had family history of stroke. Hypertension, Diabetes and smoking were the common risk factors present in the majority of the study subjects. Regarding the outcome of the disease the disability and mortality was more among the study subjects who had hypertension and diabetes when compared to non-hypertensive and non-diabetic study subjects significantly(P<0.001).

Introduction: Psoriasis is a chronic skin ailment which can be connected with an increased occurrence of other illnesses, including the metabolic syndrome. Materials and Methods: A Cross-Sectional Study of a total of 100 patients visiting the Outpatient Department of Dermatology and Venereology of at Nalanda Medical College and Hospital in Patna, for psoriasis was done. The parameters included were age at onset of disease, current age, sex, type of disease, and distribution of lesions. Data and statistical analysis were done. Results: most common age of presentation between 18-43 years, there was a predominance of males, with a male-to-female ratio of 2.41:1, service class affected most followed by business people and house wifes respectively. addiction present in 80% cases and family history positive in 28% subjects. Majority cases were of moderate to severe PASI in our study. Metabolic syndrome was diagnosed in 21 out of 100 cases and 20 out of 100 controls (p-value: 1.000). We did not find any association of psoriasis with metabolic syndrome in our study. Conclusion: Our study refuted any association of psoriasis with metabolic syndrome at the onset of disease activity in Indian patients. The plenty of reports from west approving such an association can be explained by increased risk factors like smoking, alcohol consumption, obesity and stress levels. Further, most such studies have been conducted with patients on treatment, while ours is the study on newly diagnosed patients prior to the initiation of any therapy.

Background: Accurate diagnosis is essential if patients with chronic leg ulceration are to receive optimal treatment. Multiple disciplinary approach is usually required for complete healing of chronic ulcers. Methods: A prospective study of 18 months duration was conducted on 50 consecutively admitted cases of chronic leg and foot ulcers in age group of 5-80 years of both genders. A through detailed history and clinical examination was undertaken. Local Symptoms, trophic skin changes and venous insufficiency if any was recorded. Both general and specific treatments were provided. Results: The majority of occurrences occurred in individuals aged 31-50 years, with a male to female ratio of 1.9 to 1 and a rural to urban ratio of 2.57 to 1. The majority of patients, including 76%, were illiterate. Additionally, 56% of the patients were from the lower socioeconomic level. A majority of patients (54%) had habits of smoking, tobacco consumption, or alcoholism. The most common location of the ulcer was the foot, accounting for 52% of instances, followed by the leg at 18%. The majority of ulcers (72%) were caused by trauma, whereas just a small percentage (2%) were due to ischemia. Regarding symptoms, 32% of the cases exhibited wound, pain, and discharge, while 26% showed wound and discharge. 66% of ulcers were found to have secondary infections, whereas the highest percentage of patients, 68%, required a hospital stay of approximately 2 weeks. Complete recovery occurred within around three months in 68% of instances. Conclusions: A correct diagnosis, multidisciplinary approach, optimal treatment and assessment of vascular status can facilitate healing of chronic leg ulcers in nondiabetic cases.

Introduction: Community acquired pneumonia (CAP) is defined as pneumonia that is acquired outside the hospital i.e., acquiring a pathogen from the community and is a public health concern accounting for nearly 1% of all medical admissions. Identification of pathogen and its susceptibility pattern by processing appropriate samples will help to start prompt and effective treatment. The aim of the present study is to present the microbiological data of community acquired pneumonia in this region. Materials and Methods: In the present study 535 patients with clinical symptoms and suspected of community acquired pneumonia were included in this study. All patients were requested to collect good quality sputum and those samples were processed in the Microbiology department on recommended culture media. Bacteria; isolation was done by biochemical tests. Antibiotic susceptibility testing was performed by conventional methods. Results: Predominant pathogen was Klebsiella pneumoniae isolated as 33.6% followed by Streptococcus pneumoniae (24.7%), Staphylococcus aureus (18.5%), Pseudomonas aeruginosa (15.04%), Enterobacter species (5.3%), and Acinetobacter species (2.65%). Gram negative isolates antibiotic susceptibility pattern shows around 50% were sensitive to ceftriaxone, amoxyclav, about 70 % isolates were sensitive to Ceftazidime-clavulanic acid, Piperacillin-tazobactum, Levofloxacin, and 90% isolates were sensitive to Amikacin, Meropenem, Ertapenem, Tigecycline. In this study  23.8% were Methicillin Resistant Staphylococcus aureus isolates. Conclusion: Health education  measures such as cessation of smoking, wearing a mask to avoid occupational hazards, following public health measures during epidemics, flu and anti-pneumococcal vaccination may help to reduce the incidence of community acquired pneumonia.

BACKGROUND:Atherosclerotic renovascular disease is a frequently overlooked condition and potentially correctable disease. It is estimated that approximately 1-5% of people have renovascular disease as an underlying cause of hypertension. It is also frequently associated with decreased renal function. Patients with atherosclerotic renal artery disease are at significantly increased risk for other vascular events, including coronary and cerebrovascular complications. The Atherosclerotic RAS is one of the most common causes of secondary hypertension and its prevalence in hypertensive patients undergoing coronary angiography is low, but substantially higher in patients with established peripheral (50%) and/or coronary artery disease (30%), and elderly population. The purpose of this study is to evaluate the prevalence and predictors of RAS among CAD patients with hypertension who underwent coronary angiography. METHODOLOGY: This is a hospital based cross sectional study which included100 patients presenting to department of cardiology, KGH between 1st July 2021 and 30th June 2023 with a diagnosis of coronary artery disease with Hypertension and who underwent Coronary angiography (CAG). After completion of CAG, Renal angiography (RAG) was done selectively using the same Judgkins right catheter.Data were entered in MS-Excel and analysed in SPSS V25. Descriptive statistics were represented with percentages for qualitative data, Mean with SD for quantitative data. Chi-square test, Fisher Exact test was applied for comparison of proportions. P < 0.05 was considered as statistically significant. CONCLUSION:In the present study(n=100), the prevalence of Renal artery stenosis was significant (19% ) where unilateral involvement was seen in 14% and bilateral RAS in 5%.In our study, patients’ age ranged from 32 to 76 years. Mean age was 53.8 ± 8.15 years. In our study, majority (59%) were males and 41% were females. Males were higher (68%) when compared to females (38%) in patients with RAS.Among the risk factors, smoking and dyslipidemia were higher in patients with RAS, when compared to patients with normal renal arteries, though not statiscally significant. The percentage of patients with Diabetes and obesity were similar in both groups. In our study, the presence of stage 2 hypertension and resistant hypertension are independent variables for the presence of renal artery stenosis in CAD with hypertension patients. The presence of age more than 50 years, stage 2 hypertension at presentation, resistant hypertension and triple vessel disease on coronary angiography serve as independent predictors for renal artery stenosis with statistically significant parameters in patients with coronary artery disease and hypertension in our study. Renal angiography is recommended to screen for ARAS in hypertensive patients with multiple risk factors and multivessel disease to prevent ischemic nephropathy a reversible cause of chronic renal failure.

BACKGROUND This study was conductedto assess the BODE index (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) in order to forecast the severity of COPD (Chronic Obstructive Pulmonary Disease) patients' condition and its relationship to pulmonary hypertension.METHODS This was a hospital-based cross-sectional prospective study conducted among 81 patientsclinically diagnosed to have COPD at the Department of General Medicine, Kurnool Medical College, Kurnool, from February 2021 to September 2022, after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. RESULTS The majority,i.e., 35.8% of the patients had mild PHT, followed by 33.3% with severe pulmonary hypertension, according to ECHO findings. According to BODE index scoring, 48.1% of COPD patients attending the hospital had mild severity, and 30.9% had severe COPD. A statistically significant increase in pulmonary hypertension intensity and COPD severity was seen. There was a statistically significant associationbetween theseverity of COPD and the number of exacerbations, pack years of smoking, Hbg%, BODE score, MMRC score, and ECG changes. As the severity increased, the number of exacerbations andpack years increased,while HB% was decreasing. No association with BMI, height, or weight was seen. ECG findings were co-related to pulmonary hypertension, which was statistically significant. A statistically significant increase in BODE score with a pulmonary hypertension grading increase was seen. The BODE score significantly assesses the chances of exacerbations according to the ROC curve. CONCLUSION The BODE index can provide an effective, superior, and alternative technique to evaluate the severity of the disease. It may also assist in patient follow-up. The BODE index can be of significant practical utility in a primary healthcare setting to identify people who require additional evaluation at higher referral centers and for improved management of these patients because it just takes a spirometer, which is affordable and easily made available.

Background: Diabetes mellitus (DM) is a rapidly rising chronic illness in developing countries. Glycosylated hemoglobin (HbA1c) is a widely used tool for diagnosing, screening, and managing patients with diabetes, hence proper interpretation of the HbA1c is crucial. Objectives: To investigate the risk factors affecting type 2 diabetes mellitus HbA1c and their correlation with glycosylated hemoglobin (HbA1c). Material & Methods: Diagnosed patients with type 2 diabetes mellitus during study period were enrolled in this study. Criteria for diagnosis were: HbA1c ≥ 6.5% (48 mmol /mol), Fasting plasma glucose ≥ 126 mg/dL (7.0mmol/L) 2-Hour postprandial plasma ≥ 200 mg/dL (11.1 mmol/L). Demographic data and risk factors associated with diabetes were analysed. Results: Majority of the patients (37%) were 51-70 years age group, predominantly male (63%). Among risk factors assessment, 66.5% were overweight or obese, 53.3% had positive family history of DM, 55.3% were hypertensives, 43.5% had dyslipidemia, 32.7% had a family history of CAD, 39.3% were smokers and 32% were physically inactive. HbA1c were significantly associated with the all these risk factors. Conclusion: Age, higher BMI, family history of DM, smoking, physical inactivity, hypertension, dyslipidemia and history of CVD are positively correlated with the HbA1c level. 

Metabolic syndrome (MetS) is a condition characterized by insulin resistance, diabetes mellitus, and impaired glucose intolerance, often associated with obesity, hypertension, dyslipidaemia, or microalbuminuria. The global health pattern is shifting towards chronic diseases like cardiovascular and diabetes mellitus, with a higher burden of non-communicable diseases. In India, the Epidemiological Transition Level (ETL) is <1, indicating a predominance of degenerative, non-communicable diseases and injuries. A community-based cross-sectional study was conducted to estimate the prevalence of Metabolic Syndrome (MET) and associated risk factors among the adult population in the urban field practice area of CIMS Bilaspur, Chhattisgarh. The study involved 540 systematic random samples and analyzed the dietary habits and substance abuse of 540 participants, ranging from 20 to 80 years old. The majority were from class-III socioeconomic status, with low education, bad diet, and obesity being key contributing variables. Recommendations include engaging in regular physical activity to reduce weight, abdominal obesity, and BMI, improving diet by reducing sugar, salt, and fat consumption, regular health check-ups, taking medication regularly, and quitting alcohol, smoking, and other addictions. Large-scale studies are necessary to discover all population risk variables

Introduction: Foetal growth restriction (FGR), is a condition that occurs due to various reasons.It is an important cause of foetal and neonatal morbidity and mortality. It has been defined as a rate of foetal growth that is less than the growth potential of that specific infantor as having birth weight less than two standard deviations below the mean or less than the 10th percentile of a population-specific birth weight for specific gestational age.  It has been found to be associated with a variety of adverse perinatal outcomes.These infants have many acute neonatal problems that include perinatal asphyxia, hypothermia, hypoglycaemia, polycythaemiaetc. The likely long-term complications that are prone to develop when FGR infants grow up includes growth retardation, major and subtle neurodevelopmental handicaps etc. Methods: This cross-sectional study included all growth restricted babies born in the department of Obstetrics and Gynecology at Government Medical College, IMCH Kozhikodeduring the study period and their mothers.   Multiple pregnancy with growth restriction were excluded from the study. Babies born outside IMCH but being referred to IMCH were also excluded. Socio –demographic and fetomaternal characteristics were collected after getting consent. Maternal data regarding socio-demographic variables including age, domicile (rural/ urban), socio-economic status, data regarding gestational age, nature of ANC, past obstetric history including parity. Results: Perinatal mortality rate was 64.2/1000 in growth restricted babies born to normotensive mother group.  The stillbirth rate was 36.6/1000 in growth restricted babies born to normotensive mother group. Fetal growthrestriction occurred more in rural womencompared to urban women. Women below poverty line had more fetal growth restriction compared to the women above poverty line and the difference was statistically significant. Early neonatal mortality rate was 28/1000 live IUGR babies in normotensive group. Conclusion: Mothers belonging to low socio-economic status have high risk of delivering babies with growth restriction. This is because of inadequate dietary intake, increased physical activity, passive smoking, increased rate of infections and low educational levels leading to decreased awareness regarding health care facilities. 

Background: According to recent research, people with pre-hypertension have a higher risk of developing cardiovascular diseases (CVD) and a higher rate of progression to hypertension. Undergraduate medical students, being future healthcare professionals, are not immune to this growing health issue. Their lifestyle choices and academic stress may predispose them to develop prehypertension at an alarming rate. Objectives:To estimate the prevalence of pre-hypertension among undergraduate medical students and to determine the risk factors for pre-hypertensionMethods: it was an observational cross-sectional study involving a sample size of 230 students from 2nd and 3^rd year MBBS. Students were selected using convenient sampling after obtaining oral and written consent. Students were interviewed using a predesigned and pretested semi-structured questionnaire. Blood pressure, Height and weight were measured using standard procedure.Results:The overall prevalence of prehypertension among the whole group was 35.2 % as 81 of 230 students were prehypertensive.Mixed Diet, sleep < 7 hours, habit of alcohol and smoking, Inadequate physical activity with higher odds was significantly associated with Prehypertension whereas, Family history of Hypertension and male gender had slightly higher odds but not significant.ConclusionHigh Prevalence of Prehypertension among medical students Highlights the necessity for early preventive measures targeted at raising awareness, implementing early screening, and changing lifestyle choices to lower the disease's mounting burden

Background: Stroke poses a significant societal burden, contributing to global mortality and disability. Second only to ischemic heart disease, stroke exhibits the highest mortality rates. Preventive measures involve addressing modifiable risk factors such as diabetes, hypertension, heart disease, obesity, atrial fibrillation, smoking, and alcoholism. This study aims to assess the demographic profile and associated risk factors among stroke patients younger than 45years admitted to PGIMER & Capital Hospital, Bhubaneswar, Odisha.

Methods: Conducted between October 2022, and October 2023, this single-center, cross-sectional observational study enrolled 52 stroke patients at PGIMER & Capital Hospital, Bhubaneswar, Odisha. Data analysis was performed using SPSS version 20.

Results: Of the 52 patients, 34 (65%) were male, and 18 (35%) were female, with a mean age of 32.57 ± 9.6 years. Ischemic stroke occurred in 39 (75 %) patients, while hemorrhagic stroke was observed in 13 (25 %). The middle cerebral artery territory was the most commonly affected in ischemic stroke (22, 42.30%), whereas intracerebral hemorrhage occurred in 11 (78.57%) cases. Smoking and hypertension were prevalent in 51.92% and 51.92 % of ischemic stroke cases, respectively, while hemorrhagic stroke cases showed rates of 23.07 % and 21.15%, respectively. Physical inactivity (50%), alcohol consumption (40.38%), central obesity (46.15%), and dyslipidemia (30.76%) were more frequently associated with ischemic stroke, while significant alcohol consumption (15.38%) was more linked to hemorrhagic stroke.

Conclusions: Stroke predominantly affected males and increasing age groups, with ischemic stroke being more common than hemorrhagic stroke. The most prevalent risk factors for stroke in young patients were smoking, hypertension and central obesity

Conclusion: The present study results may helpful to add knowledge about relation between, BMI, WHR and Handgrip endurance. This may give supportive knowledge to sports physician in their practice.

CONCLUSION: We can conclude from the study that there is a growing need for interventions to ensure the health of this vulnerable group and to create a policy to meet at least the essential needs of the old people. Also the common morbidities among the elderly should be considered before planning for any intervention.

Aims: To assess the incidence of Chronic Total Occlusions (CTOs) in patients with coronary artery disease and to study the symptom complex of patients with Chronic Total Occlusions (CTOs). Materials and methods: This is a prospective observational study conducted in 40 adult patients aged between 18-75 years of age, of any gender, undergoing coronary artery bypass grafting for coronary artery disease with chronic total occlusion of one or more coronary vessels and analyzed the surgical outcomes. Results:  CAD was most frequently seen in males in their sixth decade of life, with smoking being a definite possible risk factor. Chest discomfort was the most common presenting complaint of the patients with CTOs of the coronaries. CTOs were frequently associated with triple vessel disease of the coronary vessels. Surgical management of CTOs by CABG seems to be more appropriate as it can provide revascularization of all major coronary territories. CTOs have been more commonly found in the Right coronary artery, with single vessel CTO being more common than multi-vessel CTOs.  Peri-operative low cardiac output, requirement of endarterectomy and IABP support were associated with eventful outcomes and were indicators of a poorer prognosis. Majority of the CTOs were bypassed successfully and significant improvement in the left ventricular ejection fraction was noted in most of the patients post-operatively. Conclusions: Despite their variable complex anatomy, most of the CTOs were amenable to revascularization by CABG reiterating the fact that surgery still remains a definitive mode of treatment for complex CAD

Background: The purpose of this investigation was to assess the state of implants in patients with stage III/IV periodontitis at a specialised periodontal surgery which has been in use for five to 17 years. Participating in the trial were 83 patients (43 females and 40 males, mean age 64.4 (9.69) years) with a total of 213 implants. Radiography investigation, bleeding and plaque scores, and periodontal and peri-implant probing depths were among the tests performed. The Implant Disease Risk Assessment (IDRA) scores, smoking behaviours, and involvement in a supportive care programme (SCP) were noted. 39 patients had stage IV periodontitis and 44 patients had stage III periodontitis. Overall, 85% of patients reported following a regular SCP. Peri-implant viability was discovered in 37.1.7% (79 implants) of patients and 24.1% (20 patients) of implants, peri-implant mucositis in 58.7% (125 implants)/66.3% (55 patients), and peri-implantitis in 4.2% (9 implants)/9.6% (8 patients). IDRA scores showed 30.5% of implants at moderate and 69.5% at high risk. The present long-term analysis shows a high prevalence of peri-implant disease in patients treated for advanced periodontitis. These findings underline the challenges involved in the long-term maintenance of oral health in stage III/IV periodontitis patients restored with dental implants

Background: Metabolic syndrome and cardiovascular disease (CVD) significantly contribute to global morbidity and mortality. Framingham Risk score (FRS) is a widely accepted parameter to grade the 10-year risk of heart disease. In this prospective observational study conducted at our tertiary care centre, we investigated patients with metabolic syndrome and analysed them to find the correlation of serum calcium and magnesium with FRS. Methods: We evaluated 288 adult patients who presented with features of metabolic syndrome, at Karnataka Institute of Medical Sciences, Hubballi, over two years from November 2019 to December 2021. Serum calcium and magnesium venous blood samples were obtained on the patient's visit to the hospital. The study was conducted after obtaining clearance from the Institutional Ethics Committee and written informed consent from the study participants. Results: Out of 288 patients included in the study, 168 (58.3 %) were male and 120 (41.7 %) were female. The mean age among the study population was 55.99 years. The prevalence of metabolic syndrome components in the study population was as follows: 82.6% had diabetes 67.4% were obese, 51% had dyslipidaemia, and 88.9% were hypertensive (51.6% of them on treatment.  A significant history of smoking was present in 28.1%. Furthermore, the 10-year CVD risk as assessed by FRS was as follows: 23.6 % had low risk, 37.2 % had intermediate risk and 39.2% had high risk. The corrected serum calcium and magnesium demonstrated a significant association with diabetes, hypertension, cholesterol, and FRS. Patients with high corrected serum calcium levels and low serum magnesium levels exhibited this pattern. Conclusion:Serum magnesium and corrected serum calcium and can be used as indirect indicators of the severity of diabetes and hypertension. Moreover, they can also be used for assessing the 10-year risk of CVD, due to its association with FRS

Introduction: Non-communicable diseases (NCDs) have taken center stage in recent times, displacing communicable diseases as the primary cause of death in the majority of nations. Worldwide, non-communicable diseases are the main cause of death. 38 million people die from non-communicable diseases (NCDs) per year. Objectives: To study the prevalence of risk factors of NCDs in rural area of West Bengal. Methods: This community based cross sectional study was conducted Howrah, West Bengal from January 2024-March 2024. Total 400 people who were aged 15 and above were enrolled for the study. Statistical data were analysed by using Microsoft Excel and SPSS V.20 software. Results: Among the 300  people studied 46.67% were in age group of 15–35 years. 70% were having education below secondary/higher secondary. 44% belonged to lower middle and 36.67% belonged to lower socioeconomic class. 47.33% of them were either farmers or labour/ unskilled workers. In the studied population 44.67% were currently using tobacco either in the form of chewing or smoking, among these 94.03% were males. 28.66% were currently consuming alcohol, of these males comprised 90.69%. Among the studied population 19.33% were hypertensive and 11.33% were diabetics. Conclusions: The prevalence of non-communicable diseases risk factors is high in this study. It is necessary to minimize the burden of growing non-communicable disease epidemic in the society, by curbing the rates of the risky behaviours at a very early stage by lifestyle modification.   

Background: As the drug tesistance Tuberculosis is continuous to be a public health crisis, not only in the world but in India also by increasing its prevalence and incidence of R/R / MDR TB cases, the present study was planned to study the clinical social profile and treatment outcome of these patients treated with shorter MDR Regimen. Research Question: What is the clinical social profile and treatment outcome of RR/MDR TB cases treated with shorter MDR Regimen in our set up? The setting of the study was at department of Respiratory Medicine and General Medicine Government General Hospital, Government Medical College, Machilipatnam. A one year observational study was conducted during the period from January 2023 December 2023 on about 147 Pulmonary TB patients who were treated with shorter MDR regimen during the period from January 2019 to December 2022. The required data was collected retrospectively based on the available hospital records (case sheets, case registers etc.) by studying their socio-demographic profiles, clinical scenario, risk factors and  treatment outcome etc; as study variables and was analysed. Results: Among the total study subjects 73.28% were male and 27.39% were female. It was observed that the burden of the disease was more  between 21-60 years of age group (79.59%) with the Mean age was 52 years. And also it was noticed that the disease burden was more among males when compared to females significantly. Regarding the Risk factors it was observed that Malnutrition was 48.28% followed by Previous h/0 TB 67.35%, Anaemia 59.5%, Alcoholism 40%, Diabetes 37.41%, Smoking23.8% and HIV +ve 17.68% distributed respectively. With reference to Drug resistance pattern maximum observed was Rifampicin Resistance (RR) 76.87% followed by Multi drug resistance (MDR) R/R +H(B) 21% and Extensive Drug Resistance (XDR) R/R +H(B) + FQR 2% was noticed among the study subjects. In this study regarding the treatment outcome about 46.9% were Cured followed by 20.4% were treatment completed, 19% were died during the course of treatment, 7.4% were lost to follow up, 5.4% treatment changed and 0.68% were Treatment failure as observed in this study.

Introduction: Cardiovascular diseases (CVDs) are the leading cause of death globally, with middle-aged adults particularly vulnerable to developing risk factors that can lead to serious health complications. Understanding the dynamics of these risk factors is crucial for effective intervention and prevention. Objective: This study aims to assess the progression of cardiovascular risk factors in middle-aged adults through a longitudinal observational approach, providing insights into the prevalence, trends, and potential early indicators for reducing CVD incidence. Method: A longitudinal observational design of 522 middle-aged adults was selected through stratified random sampling from the Department of Cardiology, Hi-Tech Medical College & Hospital, Bhubaneswar, India. Baseline data collection, beginning in June 2019, included comprehensive health assessments, biochemical analyses, and lifestyle questionnaires. Follow-up assessments were conducted annually until June 2024. Key variables measured were blood pressure, lipid profiles, fasting glucose levels, body mass index (BMI), smoking status, and physical activity levels. Statistical analysis was performed using paired t-tests to compare baseline and follow-up data, with a p-value of <0.05 considered statistically significant. Results: Preliminary results indicate a high prevalence of hypertension (55%, p<0.01), dyslipidemia (47%, p<0.01), obesity (40%, p<0.01), and diabetes (30%, p<0.01) among participants. Over the five years, the incidence of hypertension increased to 60% (p<0.01), dyslipidemia to 52% (p<0.01), and obesity to 45% (p<0.01). Diabetes prevalence rose to 35% (p<0.01). Smoking rates slightly decreased from 25% to 22% (p=0.04), while physical inactivity remained high at 60% (p=0.03). Among urban populations, the increase in risk factors was more pronounced, with hypertension rising from 50% to 65% (p<0.01) and obesity from 35% to 50% (p<0.01). The interrelationship between obesity, hypertension, and diabetes was significant, suggesting a compounded risk for cardiovascular events. Conclusions: The study highlights the escalating prevalence of cardiovascular risk factors in middle-aged adults, emphasizing the need for early and targeted intervention strategies. Public health initiatives must focus on lifestyle modifications and continuous monitoring to mitigate these risks and reduce the burden of CVDs

Background: Gastritis, a significant public health concern worldwide, involves inflammation or irritation of the gastric mucosa. This condition is influenced by various factors such as health behaviors, socioeconomic status, lifestyle, living conditions, and habits. It can be acute, chronic, or severe and is often associated with Helicobacter pylori (H. pylori) infection. Contributing factors to gastritis include smoking, alcohol consumption, spicy foods, medications, stress, and infections. In India, the prevalence of gastritis is notable, with recent studies indicating a high incidence of H. pylori infection. This study aims to investigate the prevalence and contributing factors of gastritis among patients in a tertiary care hospital. Methodology: A descriptive, observational, non-interventional study was conducted with 150 subjects aged 14-65 years diagnosed with gastritis at MKCG Medical College and Hospital, Berhampur. Data were collected using a structured questionnaire covering socio-demographic details, dietary habits, economic status, family history, stress levels, drug use, and medical history. Ethical approval was obtained, and written consent was provided by each participant.  Results: Out of 150 subjects, 73% were male and 27% female, indicating a male predominance. The age groups 14-25 and 36-45 years had the highest prevalence. A significant proportion (75%) had a mixed diet, and 54% were alcoholics, predominantly males. Urban residents (68%) exhibited a higher incidence of gastritis. Blood group A Rh+ was predominant (46%), and 6% were hypertensive. Spicy food consumption (73%) and frequent NSAID use (61%) were notable risk factors. High stress levels were reported by 47% of the participants. Associations were found between gastritis and psychological stress, menstrual history, sleeping patterns, and educational levels. Discussion: Gastritis prevalence is influenced by male gender, urban residence, alcohol consumption, spicy food intake, and frequent NSAID use. The findings highlight the importance of targeted interventions to address these risk factors. Physical labor, particularly among males, and stress are significant contributors. The study underscores the need for preventive strategies focusing on lifestyle modifications and stress management to reduce gastritis incidence. Conclusion: This study provides a comprehensive overview of the prevalence and contributing factors of gastritis in the hospital. Males, urban residents, and individuals consuming spicy food and alcohol are at higher risk. The findings call for public health initiatives to address these risk factors through education, lifestyle changes, and stress reduction programs. Future research should explore tailored preventive strategies to mitigate the burden of gastritis in this population

Introduction: CVD is the most important cause of death all over the world. The burgeoning burden of CAD in India can be explained by the rise in prevalence of risk factors like diabetes, hypertension, dyslipidemia, smoking, obesity, physical inactivity & urbanization. The aim of the study is to compare the risk factors of patients with CAD& their siblings. Method:  It was a case-control study, conducted over a period of 1.5 years. In this study CAD patients and their siblings without CAD; age <60 years were included. Both groups were compared for CAD risk factors. Results: Total 100 patients their 100 siblings were taken. Patients were more smoker(19% patients &4% siblings p =0.001), more heavy alcohol consumption(21% patients &10% siblings p = 0.032), more moderate and high stress level(56% patients & 38 % siblings p= 0.037), more physical inactivity(70% patients &51% sibling p=0.019), more central obese(abnormal WHR for male 41% patients &25% siblings p= 0.024 and for female 21% patients &16% siblings p= 0.037), more hypertensive(40% patients & 22% siblings p=0.003), more diabetic(44% patients &11% sibling p=0.000), more intake of carbohydrate(p= 0.014), & fats(p= 0.033) and low HDL cholesterol(69% patients &46% siblings p= 0.001). Beside this among siblings’ prevalence of prehypertension, prediabetes and dyslipidemia were high. Conclusion: We found that CAD risk factors were high in patients compared to their siblings. Beside this among sibling prevalence of prehypertension, prediabetes and dyslipidemia were high. So, to prevent CAD these factors should be controlled.

According to the World Health Organization (WHO), the global tobacco epidemic stands as one of the most significant threats to public health in history. With a staggering death toll exceeding 8 million annually, the impact is profound. Smoking prevalence varies greatly between regions and even within countries of the same region. Currently, the highest rates of male smoking are observed in the Western Pacific nations. In India, tobacco usage, encompassing both smoking and non-smoking forms, remains prevalent. Smoking cigarettes is recognized as a major contributor to various neurological disorders, with oxidative stress implicated as a potential mechanism of smoking-related harm resulting brainstem hypoxia which contributes to abnormalities in brainstem auditory evoked potentials (BAEP), resulting in significant impairment of the functions of the eighth cranial nerve and the brainstem among smokers. This research investigates the profound effects of oxidative stress on brainstem auditory evoked potentials (BAEP), in tobacco smokers. The study encompasses a diverse array of measurements, including anthropometric data, blood pressure, brainstem auditory evoked potentials (BAEP) oxidative stress markers (malondialdehyde - MDA and superoxide dismutase - SOD), and serum electrolytes. The results shed light on the intricate relationship between tobacco smoking, oxidative stress, and neurological outcomes.

Introduction: Vegetarianism dates back to a time before recorded history. The present study was undertaken to compare individuals (vegetarians and non-vegetarians) lipid profile which is used to determine the risk of obesity, myocardial infarction and helps in determining the treatment has border line or high-risk cases. Aims & objectives: The present study was designed to investigate comparative study of serum lipid profile in vegetarians and non-vegetarians’ young adults, so that the effects produced by the type of dietary intake can be evaluated. Materials and methods: A total of 100 (50 vegetarians and 50 non-vegetarians) were selected from Kurnool medical college, Kurnool with exclusion criteria (Subjects with history of hypercholesterolemia, hereditary dyslipidemias, Subjects on drugs that affect the lipid profile, hypertensive’s, diabetics, heart diseases and thyroid diseases and subjects with Smoking and Alcohol). All parameters (lipid profile) were done on a Semi automated analyser (Erba chem-5x). Results: The mean values of TC (Total cholesterol), LDL, VLDL, TG (Triglycerides) are high in non-vegetarians when compared to vegetarians and HDL is high in vegetarians. The p value is <0.0001 and is considered highly significant and food good relation with vegetarian diet. Conclusion: It concludes that healthy dietary pattern maintains a favorable lipid profile.

Introduction: COPD, as defined by GOLD 2023, is a lung condition that is characterised by chronic respiratory symptoms such as dyspnoea, cough, expectoration, and exacerbations. These symptoms are caused by abnormalities in the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema), which result in persistent and often progressive airflow obstruction (1). Airflow blockage is characterised by a forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC) of less than 0.70. FEV1 is classified as Mild when it is greater than 80% of the predicted value, Moderate when it is between 50% and 80% of the predicted value, Severe when it is between 30% and 50% of the projected value, and Very Severe when it is less than 30% of the predicted value. In 2019, Chronic obstructive pulmonary disease (COPD) resulted in 3 million fatalities globally, making it the third most common cause of death (2). Cardiovascular diseases (CVDs) are a major health issue that often occurs alongside chronic obstructive pulmonary disease (COPD) and greatly increases the chance of death (3). Ischaemic heart disease (IHD), heart failure, and arrhythmias are often observed as cardiovascular diseases (CVDs) in patients with chronic obstructive pulmonary disease (COPD). The incidence rates of ischaemic heart disease (IHD), heart failure, and arrhythmias in individuals with chronic obstructive pulmonary disease (COPD) range from 19% to 61%, 11% to 31%, and 9% to 16%, respectively, depending on the specific characteristics of the research population (4,5,6). The prevalence of cardiovascular disease (CVD) was much greater in patients with chronic obstructive pulmonary disease (COPD) compared to those without COPD. Specifically, 59.7% of COPD patients had CVD, while only 28.5% of non-COPD patients had CVD (7). COPD can cause a range of abnormalities in the structure and blood flow of the heart, which can in turn affect several aspects of the electrocardiogram (ECG). The main causes of ECG changes in patients with COPD are increased airway obstruction, higher pressure on the right side of the heart, displacement of the diaphragm due to excessive inflation of the lungs, rotation of the right side of the heart in a clockwise direction, and changes in body mass index that are associated with clockwise rotation of the QRS-vector in the front of the heart(8,9). The objective of our study was to examine the alterations in electrocardiography among patients with chronic obstructive pulmonary disease (COPD) and to establish a correlation between ECG findings and the severity of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Criteria. Materials And Methods: This is a cross sectional, observational study done in patients who attended OPD and admitted in wards in department of General Medicine and department of Pulmonary Medicine in Maharajah Institute of Medical Sciences, Vizianagaram. Results: In our study most of the patients belong to age group of 51-70 years (73.2%), most common in 61- 70 years (38.6%) with male preponderance (85.3%). 59 of 64 males were smokers and 4 of 11 females has history of smoking. Conclusion: COPD is a common condition in patients with smoking and is associated with ECG abnormalities. RAD (Right Axis Deviation) is the most common ECG change observed in the study.  As the severity of the disease increases, ECG abnormalities become more common. All patients should undergo ECG to prevent cardiovascular morbidity and mortality.

Introduction: In addition to established risk factors such as smoking, diabetes mellitus, hypertension, homocysteine, C-reactive protein (CRP), fibrinogen, and albumin, coronary artery disease (CAD) is characterised by a chronic inflammatory state. Inflammation plays a significant role in the initiation and progression of atherosclerotic plaque rupture, thrombus formation, and endothelial dysfunction. Two indicators, the fibrinogen to albumin ratio, are altered, and this results in vascular endothelial dysfunction through a variety of mechanisms, including platelet aggregation, thromboxane affinity, and plaque erosion. As a result, FAR has been identified as a new inflammatory marker that is correlated with the severity of coronary artery disease. Materials And Methods: The study included 108 patients who had acute coronary syndrome (ACS) and were admitted to the IPD division of the ICCU at KIMS Hospital. The patients underwent coronary angiography (CAG) while taking into account inclusion and exclusion criteria. Serum fibrinogen and serum albumin were measured at the time of admission, and the fibrinogen to albumin ratio was computed. Written informed consent was obtained from each subject or relative in every case. A detailed clinical history, including complaints, past history, and family history, was also obtained. The angiographic severity of coronary artery disease was assessed using the Gensini risk scoring system. The Chi-square test was employed to evaluate the association between FAR and other risk variables, and the Pearson correlation coefficient was utilised to determine the linear link between Gensini score (GS) and FAR. Results:  108 patients participated in the research; 70 (64.8%) were men and 38 (35.2%) were women. The mean age was 57 years, and the patients' ages varied from 29 to 83 years. Of the 108 patients who had acute coronary syndrome, 51 (47.2%) had diabetes, 65 (60.2%) had hypertension, 7 (6.5%) had a family history of coronary artery disease, and 52 (48.2%) had smoked. 38 (35.2%) patients with coronary angiography (CAG) had single vessel disease (SVD), 63 (58.3%) with double vessel disease (DVD), and 7 (6.5%) with triple vessel disease. The 108 patients who were enrolled in the study were split into three FAR tertiles: low FAR (n = 36; <9), middle FAR (n = 36; <11.8), and high FAR (n = 36; >11.8). Of the 108 patients, ANOVA in one manner, the mean Gensini score for the low FAR group was 34.6, the mean Gensini score for the intermediate FAR group was 38.8 13.8, and the mean Gensini score for the high FAR group was 48.6 16.2 with a statistically significant p <0.001. The pearson correlation coefficient between FAR and Gensini for the 108 patients is 0.446, indicating statistical significance with a p-value of less than 0.001. Conclusion High FAR levels are strongly correlated with angiographic severity of coronary artery disease, as determined by the Gensini risk score method, in individuals with acute coronary syndrome.

Objectives-To determine the association between tobacco and peri-implant diseases in a sample of patients who had received implant-supported restorations in a university dental clinic Materials and Methods There were four hundred and fifty implants examined. Data pertaining to the individuals and the implant were assessed after a sample of patients was chosen from an electronic database. The development of smoking was thoroughly documented, including the amount of smoke smoked, the cumulative lifetime dose, the length of exposure, the intensity of the habit, and the decision to stop smoking. The main objective of the study was to determine the peri-implant status, which includes peri-implant mucositis (PM), peri-implantitis (PI), and health (H). Results: 49 patients (47.9%) did not smoke, 42 patients (35.9%) had smoked in the past, and 19 patients (16.2%) were smokers currently. Thirty-nine subjects (33.4%) showed H, while 37 subjects (31.6%) and 41 subjects (35%) showed PM and PI. Conclusions-Smoke intensity was associated with an increased risk of the development of peri-implantitis. Moreover, the risk of peri-implant diseases might be similar in those subjects who had stopped smoking for more than 21 years with respect to never-smokers.

Background: Lung cancer is one of the most frequent cancers and a major cause of cancer death worldwide. Lung cancer accounts for 11.6% of all new cancer cases identified each year and is quickly becoming the most prevalent fatal neoplastic disorder in the world, accounting for 18.4% of all cancer-related fatalities worldwide1. Objectives: 1. To study the clinical profile of newly diagnosed bronchogenic carcinoma patients. 2. To study the clinicopathological correlation among various histological types of bronchogenic carcinoma in the above patients. 3. To study the extrapulmonary manifestations and the prevalence of identifiable paraneoplastic syndromes (if present) in patients with bronchogenic carcinoma. MATERIAL & METHODS: Study Design: Prospective hospital-based observational study. Study area:  The study was conducted in the Department of Pulmonary Medicine, Government Medical College, Kadapa.  Study Period:  June 2023 – December 2023. Sample size: The study consisted of 52 subjects. Sampling method: Simple random Sampling Technique. Inclusion criteria: Patients attending hospital, diagnosed with bronchogenic carcinoma in the specified period. Study tools and Data collection procedure: Patients included in the study were selected according to the inclusion and exclusion criteria. After obtaining informed consent, data was gathered from history, objective examination of the patients and lab investigations using a semi-structured questionnaire. The localisation of the tumors was done by chest x-ray, fibre optic bronchoscopy and/or CT scan as required. Tissue diagnosis was obtained by FNAC/ biopsy or other cytology and histopathological examination of the specimen was carried out. The type pattern of paraneoplastic syndromes was noted. Results: COPD (65.38%) and Diabetes (23%) were the common co-morbidities affecting the study population followed by HTN (19.2%). H/O old PTB was noted in 11.5% of the patients and 1 patient (1.9%) had h/o ILD. 2(3.8%) patients had past h/o malignancy. One patient had h/o squamous cell carcinoma of the right ear another patient had cervical cancer and 1 (3.8%) patient had a family history of malignancy (first-degree relative). Conclusion: Lung cancer is a rapidly progressive disease with a very high mortality rate but treatment in the early stage may give a good prognosis. High-risk patients with having smoking history should be evaluated clinic radiologically with high suspicion so that early diagnosis can be made and the quality of life of patients can be improved. Primary lung cancer should always be suspected in a person presenting with unexplained cough for several weeks with other symptoms such as weight loss, and fever with non-resolving collapse-consolidation on chest radiograph.

Purpose:  To compare cardiopulmonary exercise test (CPET) parameters, including VO2, VCO2, respiratory exchange ratio (RER), respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2), and blood pressure (BP), between COPD smokers and healthy smokers, and to assess their relationship with 6-minute walking distance (6MWD) and spirometric values. Methodology: The study employed an evaluative approach to compare CPET parameters between COPD smokers and healthy smokers. Ethical approval was obtained, and the sample included 50 participants from each group. Data collection involved spirometry, 6-minute walking tests, and CPET using a treadmill under the modified Bruce Protocol. Parameters such as VO2, VCO2, RER, heart rate, and oxygen saturation were measured pre- and post-exercise. Pulmonary function was assessed using spirometry, and the results were analyzed using statistical tests, including Chi-square, with significance determined at p < 0.05. Result: This evaluative study, conducted over 15 months, enrolled 100 participants equally divided between chronic obstructive pulmonary disease (COPD) smokers and healthy smokers, revealing a male predominance (96%). Key findings included significant differences in cardiopulmonary exercise testing (CPET) parameters: COPD smokers had a mean VO2 of 429.20 ± 158.88 ml/min compared to 1569.88 ± 356.74 ml/min in healthy smokers (P < 0.001). Correlation analysis demonstrated a strong relationship between FEV1 (%) and FEV1/FVC (%) (R = 0.906, P < 0.001), while lower oxygen saturation was associated with decreased exercise performance (R ranging from -0.719 to -0.805). Post-CPET assessments showed significantly higher respiratory rates (28.24 ± 1.64 vs. 25.52 ± 3.03, P < 0.01) and heart rates (158.96 ± 7.81 vs. 169.28 ± 7.06, P < 0.01) in COPD smokers, alongside elevated O2 desaturation (9.92 ± 2.23 vs. 1.28 ± 1.05, P < 0.01). Notably, the 6-Minute Walk Distance (6MWD) was significantly lower in COPD smokers with higher smoking indices, with a mean 6MWD of 308.75 ± 49.53 meters for those with a smoking index of 151-250 (P = 0.04), illustrating the adverse effects of smoking exposure on physical performance. Conclusion: Overall, these results highlight the utility of Cardiopulmonary Exercise Testing (CPET) in identifying the underlying causes of exercise limitation and assessing the maximal exercise capacity in COPD patients. In situations where CPET is unavailable, the 6MWD serves as a practical alternative exercise test that closely correlates with CPET parameters, making it a valuable tool for evaluating the functional status of COPD patients.

Objective: To assess the relationship between levels of CRP, IL-6, and fibrinogen with the incidence of cardiovascular events with known cardiovascular risk factors. Methodology:  This prospective cohort study aimed to investigate the predictive role of inflammatory biomarkers (C-reactive protein [CRP], interleukin-6 [IL-6], and fibrinogen) in forecasting cardiovascular events. The study included 500 participants aged 40 to 75 years with at least one cardiovascular risk factor, such as hypertension, diabetes, hyperlipidaemia, or smoking history. Baseline blood samples were collected to measure CRP, IL-6, and fibrinogen levels, and participants were followed for 5 years. Cardiovascular events, including myocardial infarction, stroke, and sudden cardiac death, were recorded during the follow-up period. Results: The study found that elevated levels of CRP, IL-6, and fibrinogen were significantly associated with an increased incidence of cardiovascular events. Participants in the highest quartiles of these biomarkers had notably higher event rates compared to those in the lowest quartiles (p = 0.03 for CRP, p = 0.04 for IL-6, and p = 0.02 for fibrinogen). Cox proportional hazards regression analysis revealed that each unit increase in CRP, IL-6, and fibrinogen corresponded to a 45%, 23%, and 31% higher hazard of experiencing a cardiovascular event, respectively (p ≤ 0.05 for all biomarkers). Conclusion: This study highlights the significant role of inflammatory biomarkers in predicting cardiovascular events, especially in individuals with established cardiovascular risk factors. Elevated levels of CRP, IL-6, and fibrinogen were found to be strong predictors of adverse cardiovascular outcomes, suggesting that these biomarkers may improve cardiovascular risk stratification and help identify high-risk individuals for early intervention. Further research is needed to explore their potential integration into clinical practice for more effective prevention strategies

Background: Drug-resistant Tuberculosis (TB) poses a significant threat to TB control efforts globally. In 2022, 7.5 million new TB cases and 1.3 million deaths were reported worldwide, with India bearing a substantial burden. India accounted for 27% of the global multidrug-resistant TB (MDR-TB) cases, with 124,000 new cases in 2019. This study aims to identify independent risk factors, including social determinants, for MDR-TB among TB patients in the Kanchipuram district, India. Methods: Age and Sex matched case-control study was conducted from January 2023 to November 2023, involving 40 MDR-TB patients (cases) and 120 drug-susceptible TB patients (controls). Data were collected using a semi-structured questionnaire covering demographic profiles, treatment history, clinical history, housing conditions, and co-morbid conditions. Statistical analysis included univariate and multinomial logistic regression to identify significant predictors of MDR-TB. Results: Among the 160 participants, significant differences were observed between cases and controls regarding income, overcrowding, ventilation, and behavioral factors such as smoking and passive smoking. Key independent predictors for MDR-TB included previous TB treatment (AOR=14.82, 95% CI: 9.699-36.117), low income (AOR=9.00, 95% CI: 2.372-28.099), passive smoking (AOR=9.649, 95% CI: 7.891-31.87), overcrowding (AOR=2.062, 95% CI: 2.004-5.005), and inadequate ventilation (AOR=4.743, 95% CI: 4.227-14.907). Discussion: The study highlights the significant role of socioeconomic factors in the prevalence of MDR-TB. Factors such as low income, inadequate housing, and poor ventilation are critical determinants, exacerbating the risk of MDR-TB. Behavioral factors like passive smoking and a history of previous TB treatment also significantly contribute to the risk. Conclusion: Addressing the socio-economic determinants and enhancing health education, sanitation, and housing conditions are crucial for controlling MDR-TB. These findings underscore the need for targeted interventions and robust health policies to mitigate the risk factors and reduce the burden of MDR-TB in India. The study's insights can guide policymakers and healthcare providers in designing effective strategies for TB elimination by 2025, in line with India's national strategic plan.

Background- A number of patients living with uncontrolled blood pressure remains a challenging problem all over the world. Hypertension is responsible for 57% of all stroke deaths and 24% of coronary heart disease death in India. Therefore, it is important to know the prevalence of uncontrolled blood pressure in patients with hypertension. Aims- To Assess adequacy of blood pressure control in patients with hypertension attending medicine OPD & other medical clinics of hospital. Materials and methods- This was an observational prospective study which was conducted in the Department of Internal Medicine, Maulana Azad Medical College and Lok Nayak Hospital, located in New Delhi, India. A total of 100 diagnosed cases of hypertension fulfilling inclusion and exclusion criteria were evaluated in this study. Risk factors like adherence, no of antihypertensive medications, reduced salt intake, knowledge about hypertension, hyperlipidemia, diabetes mellitus, demographic and socioeconomic characteristics, cardiovascular disease, smoking, alcohol, physical activity and obesity were assessed. Results- The mean age of the patients was 50.48 (±12.01) years. As compared to patients with controlled BP, those with uncontrolled BP had significantly more number of females (77.4% vs. 52.2) then to males (22.6% vs. 47.8%) (P=0.01). age, Educational standard, residency, occupations, did not show a significant association with control of hypertension in our study. Socioeconomic status as a factor showed a significant association with control of hypertension. As compared to patients with controlled BP to those with in uncontrolled BP, uncontrolled BP was more common in patients with heart disease, diabetes mellitus and respiratory disease.  (12.9% vs 0.0%, P<0.01). 14% patients used tobacco in the form of smoking; 5% were current alcoholic. In the index study, 66% patients were on salt restricted diet and 73% of the patients were adhere to antihypertensive medications. Whereas patients on dual and single antihypertensive were more in controlled group 58.0% and 14.5 % respectively (P<0.01). In uncontrolled group, there were significantly more patients (77.4%) who had inadequate knowledge about HTN control vs.(23.2%) in controlled BP group, (P<0.001. Among the hypertensives, 40% subjects were physically active. BMI as a factor showed a significant association with control of BP in our study. Mean cholesterol level in uncontrolled BP group was significantly higher than controlled BP group (184.13 vs. 137.68, P≤0.01). Mean triglycerides level in uncontrolled BP group was significantly higher 157.68 (±55.98) vs. 126.29 (±38.47) in controlled group (P≤0.01). Conclusion- The present study compares parameters such salt restriction diet and adherence to antihypertensive medications in uncontrolled and controlled hypertension patients in India, which provides valuable information for researchers and authorities, who are responsible for the planning of health services. There are a limited number of researches on BP control status of hypertensive in India. So, this study will provide information about risk factors responsible for uncontrolled blood pressure in patients with hypertension. Our findings have significant public health implications that emphasize the urgency of increased awareness about blood pressure control

Background: Endothelial dysfunction marks the initial phase of atherosclerosis, a condition that leads to the thickening and stiffening of arterial walls, particularly in the aorta. This increased arterial wall thickness and stiffness result in higher arterial resistance, subsequently reducing the aortic propagation velocity (APV). This study aims to explore the relationship between APV, a relatively under-researched echocardiographic parameter, and the presence and severity of coronary artery disease (CAD) in patients experiencing acute coronary syndrome (ACS). The study is aimed.  Objective:  To assess the aortic propagation velocity and correlate it with the severity of cad using syntax score in patients presenting with acute coronary syndrome. Methods: A prospective observational study conducted in Department of Cardiology of Jawaharlal Nehru Medical College, KAHER, Belgaum between January 2O23 to December 2O23. Patients with confirmed ACS diagnosis according to fourth universal definition of acute myocardial infraction were eligible to participate in the study.  Result: A total of 292 study participants were included in this study. Among the 292 study participants, 49.7% (n=145) were in the CAD group and 5O.3% (n=147) were in the non-CAD group. The mean age of the study participants was 57.27 ± 13.4O years. Among study participants, 68.97% were male and 31.O3% were female. The mean ejection fraction in CAD and Non-CAD groups were 49 ±9.94 and 58.O6 ±6.86 respectively. The mean SYNTAX scores I of study participants in CAD group was 18.42 ±13.15. The mean SYNTAX score II PCI and SYNTAX score II CABG were 34.78 ±13.75 and 25.7 ±13.O2 respectively.  The mean AVP average in CAD group and non-CAD group were 44.32 ±33.93 and95.8 ±34.15 respectively. The prevalence of diabetes and hypertension among the study participants in CAD group were 6O.69% and 45.52% respectively. Prevalence of substance abuse like smoking, tobacco and alcohol were present in 41.38%, 46.21% and 33.1% respectively. Chest pain, dyspnoea, palpitations, and syncope were present in 89.66%, 49.66%, 1.38% and 1.38% of study participants respectively. Positive correlation of AVP was present in variables like SYNTAX Score I (p<O.O5), SYNTAX Score II CABG (p<O.O5), SYNTAX Score II PCI (p<O.O5), HbA1c (p<O.O5) and age (p<O.O5). The prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) among the study participants in CAD group were 4O.69%, 2O.69% and 38.62% respectively. The ROC curve shows 84.8% of sensitivity and 1OO% of specificity in predicting CAD by APV value. The area under the curve was O.912 (p<O.O5). Conclusion: The study showed that APV can significantly predict the CAD. This technique offers a practical, non-invasive, and cost-effective echocardiographic approach for detecting or screening coronary artery disease (CAD). It may also prove useful in assessing comorbidities associated with CAD, aiding in risk stratification, and identifying individuals at high risk for CAD. Given its predictive accuracy and potential clinical utility, APV could be integrated into routine cardiovascular assessments, particularly for patients presenting with symptoms like chest pain or those with significant risk factors. However, the study underscores the need for further large-scale, multicenter studies to validate APV’s effectiveness and confirm its applicability as a screening tool for CAD in broader populations. These future studies would help refine APV's role in clinical practice and enhance its value in preventing and managing coronary artery disease.

Introduction: COPD is characterized by a poorly reversible airflow limitation resulting from chronic inflammation. Spillover of inflammatory mediators in systemic circulation may predispose to various co-morbid states like diabetes mellitus, ischemic heart disease, osteoporosis, metabolic syndrome etc. in COPD. We aimed to study the prevalence of metabolic syndrome in COPD patients and assess association between severity of COPD and metabolic syndrome Methods: Patients with confirmed COPD were included in the study. Patients having acute exacerbation in the last 6 weeks and on hypolipidemic drugs were excluded from the study. Symptoms, smoking status, co-morbidities and treatment history were recorded in all patients. Patients were subjected to proper clinical examination and routine blood investigations. Symptom of dysnea was recorded as per MMRC functional classification, Six minute walk test(6MWT) and Visual analog scale(VAS).All patients underwent pulmonary function test(PFT), transthoracic 2D echocardiography, CT scan for visceral fat accumulation and body composition analysis. Results:101 patients were studied with 75% males and 25% females. Sixty five(65%) of patients were smokers with median smoking of 15 pack years and 37% of them were current smokers. The mean age of study population was 60.8±8.8years. The mean BMI and waist circumference of the patients were  21.7+4.1 kg/m2 and 84.5±13.4 cm respectively.    Number of patients in stage I,II,III and IV of COPD were 6,45,36 and 14 respectively. The prevalence of metabolic syndrome in Stage I,II,III & IV of COPD were 33.3%, 42.2%, 36.1% and 35.7% respectively. Overall prevalence was 38.6%. No statistical significant difference was found among groups in the occurrence of metabolic syndrome (p:0.684). The fasting blood glucose level (≥ 100 mg/dL or known diabetic) was found to be abnormal among 37.6% subjects. There was significant difference in the presence of abnormal blood glucose level between stage I/II and stage III/IV of COPD (p:0.041).No significant difference in other metabolic parameters like HDL,LDL, Triglyceride and deranged blood pressure was found between different stages of COPD. On multivariate logistic regression analysis, total body fat was only found to be the independent predictor of metabolic syndrome in COPD. Conclusion: Metabolic syndrome is an important co-morbidity in patients of COPD. However, the prevalence of metabolic syndrome in COPD is not related to its severity, exercise capacity, severity of dyspnoea, duration of disease or exacerbation frequency.

Background: Cigarette smoking is a leading cause of preventable respiratory morbidity and mortality. Small airway obstruction is an early manifestation of smoking-related lung damage and often precedes overt airflow limitation detectable by spirometry. Impulse Oscillometry (IOS) is a noninvasive tool that measures respiratory mechanics and offers potential advantages in detecting early small airway dysfunction in smokers. Methods: A cross-sectional observational study was conducted in the Department of Respiratory Medicine, SAIMS PGI, involving 96 smokers aged 18–60 years with a smoking history of ≥10 pack-years. Participants underwent detailed clinical evaluation, spirometry, and IOS testing. IOS parameters, including resistance at 5 Hz (R5), resistance at 20 Hz (R20), reactance at 5 Hz (X5), and R5–R20, were analyzed and compared with spirometry parameters such as FEV₁ and FVC. Statistical analysis evaluated the correlation between smoking intensity (pack-years) and airway obstruction. Results: The study included 96 smokers (mean age 55.2 ± 10.4 years; 70 males, 26 females) with an average smoking history of 30.5 ± 15.6 pack-years. IOS detected significant increases in R5 (6.2 ± 1.5 cm H2O/L/s) and R20 (4.5 ± 1.0 cm H2O/L/s), along with a decrease in X5 (-0.5 ± 0.4 cm H2O/L/s) compared to normal ranges (p < 0.001). These abnormalities were observed even in smokers with normal spirometry. Correlation analysis revealed a significant association between pack-years and IOS parameters (p < 0.05). Conclusion: Impulse Oscillometry is a sensitive and noninvasive tool for early detection of small airway obstruction in smokers. By detecting changes undetectable by spirometry, IOS offers potential for earlier diagnosis and intervention, reducing the risk of progression to chronic obstructive pulmonary disease.

Aim: To assess the effectiveness of a hybrid cardiac rehabilitation program on the quality of life and cardiovascular risk factors in heart failure subjects. Objectives: 1. To determine the effect of a cardiac rehabilitation program on cardiovascular risk factors and bio-physiological parameters in heart failure patients. 2.To determine the effectiveness of a cardiac rehabilitation program on health-related quality of life in heart failure subjects. 3.To assess the effect of a cardiac rehabilitation program on functional capacity in heart failure subjects. Need of the Study: While previous studies have largely focused on the effect of cardiac rehabilitation on morbidity, mortality, and re-hospitalization, there is limited research on its impact on quality of life, functional capacity, and independence in activities of daily living in heart failure patients. Furthermore, most data are derived from center-based programs, which pose practical limitations for rural populations. This study aims to develop a simple, easily implementable hybrid (canter- and home-based) cardiac rehabilitation program with tele-consultations and outpatient follow-ups. Methods: A total of 102 subjects were initially enrolled, with 100 completing the study. Descriptive statistics were used to evaluate variables such as age, SPO2, SBP, DBP, resting pulse, BMI, LDL, HDL, RBS, 6MWT, and various health-related quality of life parameters before and after the intervention. Results: Post-intervention results showed significant improvements in several key areas:SPO2: Increased from a mean of 88.60 ± 2.71 to 96.38 ± 1.95 (p=0.000).SBP: Decreased from 122.00 ± 16.58 to 114.80 ± 11.05 (p=0.000).6MWT: Improved from 502.95 ± 69.13 meters to 514.71 ± 66.31 meters (p=0.000).PCS: Increased from 23.83 ± 3.63 to 149.50 ± 3.49 (p=0.000).MCS: Improved from 29.40 ± 5.36 to 73.50 ± 5.44 (p=0.000).Statistically significant reductions were observed in smoking (p=0.001) and alcohol consumption (p=0.001) post-intervention. There were no significant changes in DBP, resting pulse, BMI, LDL, HDL, or RBS. Conclusion: The hybrid cardiac rehabilitation program significantly improved SPO2 levels, SBP, 6MWT performance, and health-related quality of life (both PCS and MCS). Additionally, there was a notable reduction in smoking and alcohol consumption among participants. These findings suggest that hybrid cardiac rehabilitation can effectively enhance the quality of life and reduce cardiovascular risk factors in heart failure patients, making it a viable option for both urban and rural populations.

Introduction Given the paucity of research on asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) and the high prevalence of co-morbidities and healthcare utilization associated with it, the current study looked at the prevalence of ACO and its clinico-radiological phenotype in patients with chronic airflow obstruction. The study was conducted at a tertiary care hospital in North India. Patients over 50 with COPD or asthma were screened for inclusion in the ACO, asthma, and COPD groups. The ACO and COPD groups were further investigated. The clinical characteristics, lung functions, health-related quality of life, and radiological features of both groups were investigated and compared. ACO was discovered in 16.3% of patients with chronic airflow obstruction (asthma and COPD). The most commonly observed symptoms at presentation in the evaluated ACO patients (n=77) were shortness of breath, wheezing, cough, and expectoration (mean age at presentation: 57.9; mean duration of illness: 8.62 years). Exacerbation rates in ACO patients were significantly higher than in COPD patients (p<0.001). The ACO group had a significantly greater mean change in FEV1 post-bronchodilator in millilitres (ml) and percentage (379.61 ml and 37.72%) than the COPD group (p<0.001). The proportion of patients with emphysema was lower in the ACO group than in the COPD group (p<0.001). The ACO and COPD groups did not differ significantly in major airway wall thickness (p=0.3), but the COPD group had a significantly higher proportion of patients with vascular attenuation and distortion (p<0.001). Patients with COPD had a higher degree of hyperinflation, according to high resolution computed tomography (HRCT) indices. This study found that patients with ACO have a distinct phenotype in terms of clinical presentation and HRCT features. More research on the radiological features of ACO is required to identify the anatomical abnormalities involved in the disease's pathogenesis and to validate the radiological features of ACO. Methods The Respiratory Effectiveness Group conducted a cross-sectional study of individuals ≥40 years old and with ≥2 outpatient primary care visits over a 2-year period in the UK Optimum Patient Care Research Database. Patients were classified into one of three source populations based on diagnostic codes: 1) COPD only, 2) both asthma and COPD, or 3) asthma only. ACO was defined as the presence of all of the following 1) age ≥40 years, 2) current or former smoking, 3) post-bronchodilator airflow limitation (forced expiratory volume in 1 second/forced vital capacity <0.7), and 4) ≥12% and ≥200 ml reversibility in post-bronchodilator forced expiratory volume in 1 second. Conclusions In summary, it has been already understood the specificity of a separate clinical entity called ACOS. Even though ACOS develops indistinct clinical and pathophysiological features that often are complicated with those of asthma or COPD, we must emphasize the importance of the syndrome. Studying further the syndrome may we discover mechanistic pathways leading to the development of COPD. And this is important because it is widely known that patients with COPD often are underdiagnosed, possibly for decades. By recognizing common risk factors it will, maybe, become possible to understand and modify the progressive deterioration of lung function, which leads to COPD

Background: Acute myocardial infarction has been reported to have poor long-term outcome in young adults. Hence, identifying the risk factors is necessary for primary and secondary prevention. This study was done to identify the risk factors for young myocardial infarction. Materials and Methods: 86 patients of myocardial infarction admitted at IGMC Shimla were included in the study and their demographic profile and risk factors were studied followed by coronary angiography. Observations: Out of 86 patients studied, maximum number of patients (53.48%) were in age group of 40-45 years with mean age of 38.4 years. 89.5% patients were male. ST segment elevation myocardial infarction (72%) was more commonly observed on ECG. Anterior wall and Anterolateral wall were the most common areas involved with prevalence of 35.4% and 30.6%, respectively. Smoking was the most common risk factor present in 93.02% cases. Hyperhomocysteinemia was present in 84.88% patients while 82.55% patients had ratio of ApoB/ApoA1 > 0.8. Diabetes mellitus and hypertension were present in 36.04% and 26.74% patients, respectively. Most common lipid abnormality observed was raised LDL followed by low HDL. Most common abnormality seen on coronary angiography was single vessel disease, seen in 62.71% patients. Conclusion: Acute myocardial infarction in young patients is more common in men in the Sub-Himalayan region. Smoking is the most common risk factor. ST elevated myocardial infarction with anterior wall involvement is the most common presentation. Single vessel disease is most commonly seen.

Introduction Coronary artery bypass grafting (CABG) is a highly successful surgical treatment for the relief of angina and prolongs life in patients with coronary artery disease (CAD). Preoperative renal dysfunction is a significant risk factor that influences the outcome in patients undergoing CABG surgery. Mild renal dysfunction is an adverse prognostic indicator in patients with coronary artery disease. Several studies showed that patients with mild renal dysfunction have an increased risk of dying within 30 days after coronary surgery. Patients with renal dysfunction who require CABG represent a complex group of patients with accelerated atherosclerosis and advanced cardiovascular disease. Methods And Materials This is a prospective study was conducted in the Department of Cardiothoracic and vascular surgery, Yashoda Hospital, Secunderabad. OPCAB was performed with the Octopus-Evolution tissue stabilizer system device for target coronary artery stabilization. A mean systemic arterial pressure was maintained around 65 to 70 mmHg throughout the procedure. An intracoronary shunt  was used in all target coronaries greater than 1.25mm in diameter during construction of distal anastomosis. Humidified carbon dioxide blower /mister was used to disperse the blood from the anastomotic site while constructing the distal anastomoses Results The mean age in mild group was 59.05±7.60 and 56.37±9.06 in normal group, p=0.15. In mild group 16 (40.00) were females and 24 (60.00) were males whereas 10(25.00) were females and 30 (75.00) were males in normal group, p=0.15(figure 2). Preoperative variables such as BMI>30 (p=0.30), Smoking (p=1.00), Hypertension (p=0.33), Diabetes mellitus (p=0.57), Hyperlipidaemia (p=0.63), COPD (p=0.80), preoperative MI (p=0.81) were compared between the mild and normal groups and none of the baseline variables were significant between the groups Conclusions There was no significant difference in the patients undergoing off-pump CABG with normal renal function and mild renal dysfunction in terms of short-term mortality, myocardial infarction, stroke, or renal failure requiring dialysis. Off-pump CABG is more reno-protective for patients with normal renal function but for patients with mild renal dysfunction may need preoperative assessment of renal function by GFR in addition to serum creatinine levels to stratify the risk for postoperative renal dysfunction and to optimize measures for renal preservation during surgical myocardial revascularization

Introduction Bronchiectasis a chronic lung condition, defined as the abnormal, irreversible dilation of the bronchi and bronchioles, where the elastic and muscular tissue is destroyed by acute or chronic inflammation and infection.  This anatomical definition has been evolved from the original description of ectatic bronchi found in pathological specimens in the year 1819. Bronchi, mostly medium sized, are abnormally dilated and bronchial wall shows inflammatory changes. Such changes result from disordered anatomy of bronchial tree, bacterial colonization and chronic host inflammatory response. Materials and Methods This is a prospective study was conducted in the Department of Respiratory medicine at Tertiary Care Teaching Hospital. Data were collected from inpatients diagnosed with bronchiectasis with or without asthma over a period of 1 year. Patients who had not received a chest HRCT scan examination or who had indecipherable HRCT scan images were excluded. Patients with other diseases (e.g. chronic obstructive pulmonary disease, allergic bronchopulmonary aspergillosis, α1-antitrypsin deficiency, significant immunodeficiencies and respiratory carcinomas) were also excluded. All aspects of the study were performed in accordance with relevant guidelines and regulations. Results In the present study, 618 BE were analyzed and divided into 2 groups into BE with asthma (n = 144, 23.3%) and those without asthma (n = 474, 76.6%). The characteristics of the patients are shown in Table 1. Among the 518 patients, 242 (53.3.%) were female and the median age of all patients was 65.6 years (IQR, 59.8–71.5 years). BE with asthma had higher BMI (23.8 vs. 100 Patients with asthma had more frequent hospitalizations, outpatient visits, and antibiotic usage compared to those without asthma. Conclusion The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.

Introduction Heart failure (HF) is as a clinical condition explained by current or previous complaints like breathlessness, ankle swelling, and tiredness, along with signs like elevated JVP, pulmonary crepitation’s, and peripheral oedema, all of which are caused by an anatomical and/ or physiological cardiac abnormality and confirmed by at least 1 of the following: raised BNP levels or verifiable evidence of respiratory, cardiac or systemic congestion Materials And Methods This is a observational study was conducted in the Department of General Medicine, Mahavir Institute of Medical Sciences. Two hundred twenty patients who were admitted to the ICU and who underwent the measurement of serum UA were enrolled in this study. AHF was defined as either new-onset HF or the decompensation of chronic HF with symptoms sufficient to warrant hospitalization. HF was diagnosed according to the Framingham criteria for a clinical diagnosis of HF, based on the fulfilment of two major criteria or one major and two minor criteria. Results  Age was not significantly associated with uric acid levels (P=0.153). However, a trend was observed where patients aged 71-80 years had the highest proportion of high uric acid (75%), while those aged 41-50 years had a lower proportion (28.57%). Men and women had similar uric acid levels (P=0.550). Patients with COPD, dilated cardiomyopathy, and coronary artery disease had slightly higher uric acid levels, but the association was not statistically significant. Among co-morbidities, diabetes, hypertension, smoking, and alcohol consumption were not significantly different between high and low uric acid groups. However, patients with high uric acid had significantly higher rates of ICU admission (93.55%) and mortality (94.40%), suggesting a strong association between elevated uric acid and worse clinical outcomes. Conclusion This study confirms that elevated serum uric acid is an independent predictor of worse clinical outcomes in CHF. Patients with higher UA levels have more severe disease, increased ICU admission, and significantly worse survival rates. Given these findings, uric acid measurement should be integrated into routine CHF risk stratification. Future research should explore whether lowering UA can directly improve patient outcomes and reduce cardiovascular mortality.

Background: Anastomotic leakage (AL) is a significant postoperative complication following small bowel anastomosis, contributing to increased morbidity and mortality. Identifying risk factors for AL can aid in improving surgical outcomes. This study evaluates demographic, clinical, biochemical, and intraoperative predictors of AL and their impact on patient prognosis. Methods: A prospective observational study was conducted at Burdwan Medical College & Hospital, enrolling 50 patients who underwent small bowel anastomosis. Patients were assessed for demographic variables, preoperative risk factors, biochemical markers, intraoperative parameters, and postoperative outcomes. Statistical analysis included chi-square tests, t-tests, and multivariate logistic regression. A Kaplan-Meier survival analysis was performed to evaluate postoperative survival outcomes.

Results

• Incidence of AL: 6 out of 50 patients (12%).
• Demographic Factors: AL was most prevalent in the 41–50 years age group (66.6%, p=0.613) with a male predominance (83.3%, p=0.927).
• Preoperative Risk Factors: ASA score III was significantly associated with AL (83.3% of cases, p=0.05). All AL patients were smokers (p=0.05) and 66.7% were alcohol consumers.
• Biochemical Markers: AL patients had significantly lower albumin levels (3.28±0.14 vs. 4.16±0.47, p=0.034) and hemoglobin (9.26±0.77 vs. 10.73±0.34, p<0.0001).
• Intraoperative Factors: Longer operative time was significantly associated with AL (182.50±4.18 vs. 150.97±13.06, p=0.05). Lack of mechanical bowel preparation (50%, p=0.006) and absence of prophylactic drainage (66.7%) were also linked to AL.
• Multivariate Analysis: ASA III status, low albumin, smoking, and prolonged operative time were independent predictors of AL.
• Survival Analysis: Kaplan-Meier analysis showed 100% survival at 2 months, despite AL cases experiencing longer postoperative recovery.

Conclusion: Anastomotic leakage remains a critical complication influenced by ASA III status, hypoalbuminemia, smoking, prolonged operative time, and lack of prophylactic drainage. Identifying high-risk patients and optimizing perioperative care can improve surgical outcomes. Further large-scale studies are recommended to validate these findings.

Keywords: Anastomotic Leakage, Small Bowel Anastomosis, Risk Factors, ASA Score, Hypoalbuminemia, Surgical Outcomes, Kaplan-Meier Analysis.

Introduction: Pulmonary hypertension (PH) is a common and serious complication of chronic obstructive pulmonary disease (COPD), contributing to increased morbidity and mortality. Identifying the prevalence and associated risk factors of PH in COPD patients is crucial for early detection and management. Objectives: To estimate the prevalence of PH in patients with COPD and identify significant risk factors contributing to its development. Methods: This cross-sectional observational study included 200 COPD patients meeting the GOLD criteria. Clinical data, spirometry results, and echocardiographic measurements were collected to assess the presence of PH (defined as RVSP > 25 mmHg). Multivariate logistic regression was performed to identify independent risk factors for PH. Results: The prevalence of PH in the study population was X% (exact value derived from analysis). Key risk factors associated with PH included advanced GOLD stage, severe airflow limitation (FEV1 < 50%), prolonged smoking history (>20 pack-years), chronic hypoxemia (SpO2 < 90%), and elevated BMI (>30 kg/m²). Patients with PH had significantly worse clinical outcomes and quality-of-life scores compared to those without PH. Conclusions: PH is prevalent in COPD patients, particularly in those with advanced disease and specific risk profiles. Early identification of at-risk patients through regular echocardiographic screening and risk stratification could improve clinical outcomes and guide targeted therapeutic interventions

Introduction: Failed thrombolysis in acute ST elevation myocardial infarction (STEMI) patients is not so uncommon and carries grave prognosis, especially in non-PCI capable settings. Various factors can affect the probability of having a successful or failed thrombolysis after fibrinolytic therapy in acute STEMI patients. We aim to study the clinical and coronary angiographic profile of acute STEMI patients with failed thrombolysis and compare it with those having successful thrombolysis. Material & methods: This was a cross sectional, observational, single centre study including 100 acute STEMI patients who received thrombolytic therapy and underwent coronary angiography. Those having contraindication for thrombolysis or undergoing primary percutaneous coronary intervention were excluded. The results were analysed statistically. Results: The mean age of 100 subjects was 57.92 ± 12.36 years (range 28 – 81 years) with male-female ratio 4:1. The mean window period was 5.89 hrs. 54% had anterior wall myocardial infarction (AWMI). Tenecteplase, streptokinase, alteplase and reteplase were used as the thrombolytic agents in 35%, 31%, 19% and 15% cases respectively. 81% had successful thrombolysis and 19% had failed. 86.9% patients presenting within 9 hrs had successful thrombolysis, compared to only 50% presenting after 9hrs. (p=0.003) 27.8% patients of AWMI had failed thrombolysis whereas only 8.7% with inferior territory infarction had failed thrombolysis (p=0.015). Single-, double- and triple vessel disease was seen in 30%, 35% and 24% respectively with left main involvement in 9%. No association was seen with single or multivessel involvement, thrombolytic agent used, age, gender, religion or risk factors such as smoking, hypertension and diabetes. LCx and RCA had higher proportions of successful thrombolysis (94.1% and 89.6% respectively) compared to LAD (72.2%, p=0.049). 90.1% cases of successful thrombolysis had angiographically significant lesion requiring revascularization. Conclusion: Late presentation, anterior territory involvement and LAD occlusions have higher chances of failed thrombolysis in acute STEMI patients. Coronary angiography and revascularization should promptly be considered in the post-thrombolysis management of acute STEMI patients particularly in failed thrombolysis.

Background: Chronic Obstructive Pulmonary Disease (COPD) is currently among the leading three causes of death globally, with 90% of these fatalities occurring in low- and middle-income countries (LMICs).1 In 2012, over 3 million individuals lost their lives due to COPD, which accounted for 6% of all deaths worldwide. OBJECTIVES:  To compare the duration of smoking in pack years first-day values of pH PaCO2 in predicting the need for mechanical ventilation in Acute Exacerbation of COPD. To compare S. Albumin, Glasgow coma scale, APACHE II score and Premorbid functional status to predict the need for mechanical ventilation in Acute Exacerbation of COPD. MATERIAL & METHODS:  Study Design: Prospective hospital-based observational study. Study area:  The study was conducted in the Department of Pulmonary Medicine, Katuri Medical College and Hospital, Guntur.  Study Period:  June 2022 to May 2023. (1 year).  Sample size: The study consisted of 100 subjects. Study population: The present study was conducted on 100 cases, including males and females, from Pulmonology OPD, Katuri Medical College and Hospital, Guntur.  Sampling method: Simple random Sampling Technique.Results: Of the 100 COPD patients, 39 had a GCS < 13, of whom 29 eventually needed mechanical ventilation, whereas only 20 of 61 patients with GCS >13 eventually needed mechanical ventilation. The p-value of <0.03 obtained by our study indicates that GCS< 13 is an independent predictor of the need for mechanical ventilation in COPD patients. CONCLUSION: In conclusion, COPD predominantly affects males and individuals over 50, with smoking being the leading cause. Key predictors for mechanical ventilation in acute exacerbations include long smoking history, low arterial pH (<7.2), altered mental state (GCS <13), high APACHE II score (>15), low serum albumin (<3.5 g/dl), elevated PaCO2 (>60 mm Hg), and poor pre-existing functional status (Menzies Grade III/IV). These factors help identify high-risk patients early, enabling timely intervention.

Background: Cardiovascular diseases (CVD) are the leading cause of global mortality, with coronary artery disease (CAD) being the most significant contributor. This is particularly concerning in low- and middle-income countries like India, where the prevalence of CAD is on the rise. Traditional risk factors such as hypertension, diabetes, and smoking are well-documented, but emerging non-traditional factors like testosterone levels have drawn attention in recent research. Testosterone is thought to impact cardiovascular health, and its deficiency has been linked to increased CAD risk. However, the association between testosterone and CAD severity remains inconclusive, especially in India, where limited data exists. This study aimed to explore the correlation between serum testosterone levels and the angiographic severity of CAD in middle-aged Indian men. The study involved 88 male participants aged 40-60, undergoing coronary angiography. The clinical profiles of participants, including traditional CAD risk factors, were recorded, and testosterone levels were measured. CAD severity was assessed using GENSINI and SYNTAX scoring. Despite high levels of traditional risk factors, the study found no significant correlation between testosterone levels and CAD severity, as indicated by both Pearson and Spearman correlation coefficients. Moreover, multiple linear regression analysis revealed that traditional risk factors and testosterone levels did not independently predict CAD severity. In conclusion, while traditional risk factors remain crucial in CAD management, this study highlights that testosterone levels do not independently correlate with CAD severity. These findings suggest that the role of testosterone in CAD pathophysiology is complex and warrants further investigation, particularly in the Indian population, to better understand its contribution

Introduction: Portopulmonary hypertension (PoPH) is a severe complication of chronic liver disease (CLD) caused by pulmonary vascular remodeling due to portal hypertension. Early detection is essential, particularly in liver transplant candidates. This study assesses the prevalence, clinical characteristics, and risk factors for PoPH in CLD patients. Material and Methods: A prospective observational study at Dr. N Y Tasgaonkar Institute of Medical Science (January 2023–January 2025) enrolled 100 CLD patients. Clinical, biochemical, imaging, and hemodynamic assessments were performed, including transthoracic echocardiography (TTE), right heart catheterization (RHC), pulmonary function tests (PFT), and six-minute walk test (6MWT). PoPH was diagnosed per ESC/ERS guidelines. Statistical analysis included chi-square tests, t-tests/Mann-Whitney U tests, and multivariate logistic regression. Results: PoPH prevalence was 29% (54% mild, 8% moderate, no severe cases). Mean age was 53.42 ± 9.13 years, with 75% male. Alcoholic liver disease (46%) and NAFLD (28%) were the most common etiologies. Higher BMI (p = 0.002), male sex (p = 0.041), smoking (p = 0.032), and comorbidities (p = 0.023) were significantly associated with PoPH. Pulmonary function impairment (FEV1 < 70%, p = 0.028) and reduced exercise tolerance (6MWT < 350m, p = 0.008) were significant. Liver disease severity (Child-Pugh, p = 0.015; MELD, p = 0.041) was strongly linked to PoPH. Conclusion: PoPH is prevalent in 29% of CLD patients, with BMI, male sex, smoking, comorbidities, and liver disease severity as major risk factors. Pulmonary function impairment and reduced exercise capacity underscore the need for early screening and cardiopulmonary assessment. Routine echocardiography and pulmonary function testing should be prioritized for early detection and management.

Background: Tuberculosis (TB) is a significant global health challenge, with India accounting for 27% of global cases. Despite improved treatment success rates, the long-term impact of post-pulmonary TB sequelae remains inadequately studied, particularly in high-burden countries. This study aimed to evaluate the pulmonary function abnormalities in post-pulmonary tuberculosis cases. Methods: A hospital-based observational study was conducted on 300 post-pulmonary TBpatients at a tertiary care center from September 2022 to March 2024. Thestudy utilized comprehensiveassessment methods including clinical evaluation and pulmonary function testing using computerized spirometry. Risk factors weresystematically evaluated, and statistical analysis was performed with significance set at p≤0.05. Results: Thestudypopulation (n=242)(meanage59.33±12.18years) showed male predominance(76.03%) and primarily rural residence (79.8%). History of smoking in 52.1% and biomass fuel exposure in 19.8% cases. Common clinical manifestations included shortness of breath (87.6%), cough (77.7%), and expectoration (59.5%). Spirometry wassuccessfully performed in 242 cases out of 300 cases. Spirometry revealed pulmonary function abnormalities in 89.26% of cases: restrictive pattern in 90 cases (37.19%), mixed pattern in 64 cases (26.45%), and obstructive pattern in 62 cases (26.62%). 98 cases (40.5%) had severe to very severe pulmonary function abnormalities. Conclusion: PostTB pulmonary function abnormalities are prevalent and associated with significant pulmonary function abnormalities, underscoring the need for comprehensive post-TB care. Strategies should include pulmonary rehabilitation, regular lung function monitoring, and interventions targeting modifiable risk factors like smoking and incomplete treatment adherence to improve long-term outcomes.

Background: Colorectal cancer (CRC) is a major global health concern, with increasing incidence linked to lifestyle factors. This study aimed to evaluate the association between dietary habits, physical activity, smoking, alcohol consumption, family history, and comorbidities with CRC risk. Methods : A case-control study was conducted with 100 participants (50 CRC cases and 50 controls). Data on demographics, diet, physical activity, smoking, alcohol use, family history, and comorbidities were collected. Statistical analysis was performed to determine significant associations using chi-square tests and p-values (<0.05 considered significant). Results: Cases had a significantly higher BMI (27.1 ± 3.4 vs. 24.5 ± 2.8 kg/m², p < 0.05). High red meat intake (>3 times/week) was more frequent in cases (68%) than controls (34%) (p = 0.01), whereas low fiber intake was observed in 72% of cases vs. 40% of controls (p = 0.003). Sedentary lifestyle was more common in cases (66%) than controls (38%) (p = 0.02). Smoking (44% vs. 22%, p = 0.04) and alcohol consumption (52% vs. 30%, p = 0.03) were significantly associated with CRC risk. A positive family history was observed in 28% of cases vs. 10% of controls (p = 0.02). Colonoscopy screening was significantly lower among cases (18% vs. 42%, p = 0.01). Diabetes (34% vs. 18%, p = 0.04) and hypertension (40% vs. 26%, p = 0.05) were more prevalent in cases. Conclusion: Unhealthy dietary habits, sedentary lifestyle, smoking, alcohol consumption, and lack of screening significantly increase CRC risk. Public health strategies should focus on risk reduction through lifestyle modifications and early screening programs.

Background: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality globally, with arrhythmias representing a frequent and significant complication. These arrhythmias, which can range from benign to life-threatening, are closely associated with the severity of myocardial injury and contribute to poor short- and long-term outcomes. This prospective observational study aimed to investigate the incidence, types, and outcomes of arrhythmias in patients with AMI admitted to the intensive coronary care unit at SVRRGGH, Tirupati. A cohort of 100 patients was assessed based on clinical features, ECG evidence, blood biomarkers, and imaging. The study found that the majority of patients were aged 41-70 years, with a significant male predominance (83%). Lifestyle factors such as smoking and alcohol use were common, and hypertension and diabetes were prevalent comorbidities. The most common type of myocardial infarction was Inferior Wall Myocardial Infarction (INFWMI). Arrhythmias, particularly ventricular premature contractions (VPCs), were observed in a significant number of patients, with spontaneous resolution noted in some cases. The study highlighted the relationship between the location of the myocardial infarction and the occurrence of specific arrhythmias, with no significant correlation found between MI type and mortality. Additionally, factors such as age, gender, and comorbidities influenced arrhythmic patterns and outcomes. These findings suggest that arrhythmias in AMI patients can often resolve spontaneously but require careful monitoring and timely intervention. The study underscores the importance of personalized treatment strategies and further research to refine management techniques and improve patient outcomes, particularly for those with high-risk factors such as comorbidities and lifestyle behaviors.

Background: COPD (Chronic Obstructive Pulmonary Disease) is a chronic inflammatory illness. Air trapping and gradual airflow limitation are two consequences of these pathological alterations that can directly result in dyspnoea and other hallmark symptoms, as well as a decline in health. The CAT is a useful tool for assessing a patient's health and the severity of their COPD symptoms. CAT is a patient-completed questionnaire; certain issues including subjectivity and unilaterally are unavoidable during the assessment. We aim to study the relationship between COPD Assessment Test (CAT) score and severity of Airflow obstruction in stable COPD patients and to determine whether higher CAT score correlates with the frequency of COPD exacerbation. Method: Hospital based cross-sectional observational study conducted among 131 patients, age range between 43 to 90 years, in all stable COPD patients. Assessment was done by CAT (COPD assessment test) score and severity of airflow obstruction by spirometry in the Department of Respiratory Medicine, from January 2023 to December 2024. Results: Mild airflow obstruction was found in 46.6% of cases, moderate in 42.7%, severe in 10.7%, and none had very severe obstruction. The severity distribution was significantly related to gender, history of childhood respiratory infections, disease impact level based on CAT scores, and frequency of exacerbations. Higher CAT scores correlated with more severe airflow obstruction. Patients with a "very high" CAT score had a significantly higher prevalence of severe airflow obstruction (P-value < 0.05). A significant relationship was observed between the frequency of exacerbations and both the CAT scores and airflow obstruction severity. Patients with more frequent exacerbations exhibited higher CAT scores and more severe airflow obstruction (P-value < 0.05).There was a significant inverse relationship between the CAT score levels and the mean FEV1 (% predicted), indicating that a higher disease impact level correlates with worse lung function (P-value < 0.05). Conclusion: The importance of regularly using CAT scores in clinical practice to better understand the severity of COPD and to tailor treatment plans according to individual patient risk factors, such as age, gender, smoking history, and past respiratory health. This approach can help improve disease management and outcomes for COPD patients

Background: Alcohol consumption is a significant public health concern, contributing to various forms of injuries and medico-legal cases. Blood Alcohol Concentration (BAC) is commonly measured to assess the influence of alcohol on injury severity and clinical outcomes. Breath alcohol analyzers provide a non-invasive, rapid method for estimating BAC. This study aimed to assess alcohol levels using a breath alcohol analyzer in medico-legal cases reporting to the casualty of a tertiary care hospital and to evaluate its association with injury severity and socio-demographic factors. Materials and Methods: A cross-sectional analytical study was conducted in the Emergency Department of a tertiary care hospital over two years. A total of 246 medico-legal cases were analyzed, and breath alcohol levels were measured using a handheld breath alcohol analyzer (AlcoMate Premium Model AL 7000). Data on age, gender, occupation, smoking status, time of incident, nature, and severity of injuries were collected and statistically analyzed using SPSS software. Results: Among the 246 medico-legal cases, 205 (83.3%) were males, and 41 (16.7%) were females. A total of 49 (19.92%) cases tested positive for breath alcohol, with a higher proportion among males (22.0%) than females (9.8%). The majority of alcohol-positive cases (46.93%) were aged 21–30 years. The most common injury type among alcohol-positive cases was road traffic accidents (75.5%), followed by accidental injuries (10.2%). Breath alcohol positivity was significantly associated with smoking (OR = 3.31, 95% CI: 1.73–6.31, p = 0.0003). Of the alcohol-positive cases, 57.14% sustained simple injuries, while 42.8% had grievous injuries. The highest proportion of cases (63.5%) occurred between 6 PM and 6 AM. Conclusion: The study found a significant association between alcohol consumption and injury severity, particularly in road traffic accidents and assault cases. Young adults and service-class individuals were the most affected groups. Breath alcohol analysis is an effective, non-invasive tool for rapid alcohol estimation in medico-legal cases. The findings highlight the need for stricter regulations on alcohol use, especially in high-risk populations, and the integration of alcohol screening into emergency department protocols.

Background Hypertension is a leading risk factor for cardiovascular diseases, significantly contributing to morbidity and mortality worldwide. The prevalence of hypertension varies across urban and rural populations due to differences in lifestyle, socioeconomic status, and healthcare access. This study aims to determine the prevalence and correlates of hypertension among adults in urban and rural areas of Dehradun, India. Objective To assess the prevalence of hypertension and its associated risk factors among adults in urban and rural Dehradun, comparing sociodemographic and lifestyle determinants. Methods A cross-sectional study was conducted among 400 adults (200 urban, 200 rural) aged 30-65 years in Dehradun. Participants were selected through stratified random sampling from community health centers. Blood pressure measurements were taken using a standardized sphygmomanometer, and hypertension was defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, based on WHO criteria [1]. Data on sociodemographic factors, lifestyle habits, comorbidities, and dietary intake were collected via structured interviews. Chi-square tests and logistic regression analyses were performed to assess associations. Results Hypertension prevalence was higher in urban (42%) compared to rural (28%) populations. Key risk factors identified included obesity, physical inactivity, high salt intake, smoking, and alcohol consumption. Urban participants had higher obesity rates (35% vs. 18%), whereas rural participants had higher tobacco use (22% vs. 14%). Multivariate analysis showed significant associations between hypertension and BMI >25 (OR=2.3, p<0.01), sedentary lifestyle (OR=1.9, p<0.05), and excessive salt intake (OR=1.7, p<0.05) [2]. Conclusion The study highlights the higher burden of hypertension in urban areas of Dehradun, primarily due to lifestyle factors such as obesity and physical inactivity. Interventions targeting diet modification, physical activity promotion, and tobacco cessation are crucial for hypertension control. Strengthening primary healthcare access in both urban and rural settings can help mitigate the growing burden of hypertension [3].

Background: Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients. Objective: To assess the bleeding and cardiovascular outcomes associated with DAPT in patients with varying degrees of baseline thrombocytopenia undergoing PCI. Methods: A prospective cohort study was conducted at a tertiary care hospital, enrolling 368 patients with thrombocytopenia undergoing PCI. Patients were stratified into mild (100,000– 150,000/mm³), moderate (50,000–100,000/mm³), and severe (30,000–50,000/mm³) thrombocytopenia. Outcomes included bleeding complications (BARC criteria), major adverse cardiovascular events (MACE), in-hospital mortality, and post-PCI complications. Univariate and multivariate models were used for analysis. Results: Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01). Conclusion: Moderate and severe thrombocytopenia are independent predictors of bleeding and cardiovascular events in patients on DAPT post-PCI. These findings emphasize the need for stratified management in this high-risk group. 

Introduction. Alcohol causes around 4.5 million deaths a year, making it the fourth most important risk factor for disease burden worldwide. A variety of problems, such as excessive use, abuse, dependence, and addiction, are included in the category of alcohol use disorders (AUD). Alcohol withdrawal syndrome (AWS) is a well-known disorder that happens when severe or continuous drinking is abruptly stopped, whether it's intentionally or unintentionally. Acute and long-term alcohol use can cause hypomagnesemia and other electrolyte abnormalities. The primary causes of magnesium deficiency in these individuals include insufficient intake, malnutrition, losses due to vomiting, and urinary losses related to ethanol metabolism. Hence the present study was done to measure serum magnesium levels in chronic alcoholic patients who have abstained from alcohol for at least 6 hours and also the relationship with severity of alcohol withdrawal. Methodology: A cross-sectional study was done on 100 patients with alcohol withdrawal symptoms who gave consent at King George hospital, Visakhapatnam. Alcohol withdrawal symptoms severity was measured with the help of the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) scale and serum magnesium levels were measured. Details like age, hypertension, diabetes and smoking were also studied. Results: The Mean age of the study participants is 40.86 ±11.28 years. There was a significant positive correlation between CIWA-Ar scores and the duration of alcohol intake (r = 0.464), and a significant negative correlation with serum magnesium levels (r = -0.802). Conclusion: Longer alcohol consumption is associated with higher withdrawal severity, while higher levels of serum magnesium are associated with lower withdrawal severity.

Background: Cervical cancer remains one of the leading causes of morbidity and mortality among women in developing countries. Early detection through cytological screening is pivotal in reducing disease burden. Liquid-Based Cytology (LBC) offers several advantages over conventional Pap smears, including improved sample adequacy and diagnostic accuracy. This study aimed to evaluate the utility of LBC in detecting early cervical neoplastic changes among high-risk women. Materials and Methods: A prospective observational study was conducted over a period of 12 months in a tertiary care hospital. A total of 300 high-risk women, identified based on factors such as early sexual activity, multiple sexual partners, history of sexually transmitted infections, and smoking, were enrolled. Cervical samples were collected using a cytobrush and processed using the LBC technique. Cytological findings were classified according to the Bethesda System 2014. Colposcopic-guided biopsy was performed in cases with abnormal cytology to confirm histopathological correlation. Results: Out of 300 women screened, satisfactory samples were obtained in 294 cases (98%). Cytological abnormalities were detected in 66 participants (22.4%), of which 30 (10.2%) showed Low-grade Squamous Intraepithelial Lesions (LSIL), 18 (6.1%) had High-grade Squamous Intraepithelial Lesions (HSIL), and 6 (2.0%) revealed Atypical Squamous Cells of Undetermined Significance (ASC-US). Histopathological correlation confirmed neoplastic changes in 92% of HSIL and 80% of LSIL cases. LBC demonstrated a sensitivity of 91.3% and specificity of 95.7% in detecting cervical neoplasia. Conclusion: Liquid-Based Cytology is a reliable, sensitive, and specific screening tool for the early detection of cervical neoplasia, especially in high-risk women. Its adoption in routine gynecological screening programs can significantly enhance early diagnosis and timely intervention, thereby reducing the cervical cancer burden.

Background: Chronic Total Occlusions (CTOs) represent a complete blockage of a coronary artery persisting for more than three months. These lesions are common in patients with chronic stable angina but may also occur in those with non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA). Historically considered complex with high procedural risks, CTO interventions have seen significant advancements in safety and success rates due to improvements in technology and operator expertise. Successful revascularization has been shown to improve myocardial perfusion, alleviate symptoms, and enhance overall cardiovascular outcomes.

Aims and Objectives:

1. To study the clinical and angiographic profile of patients undergoing CTO angioplasty at a tertiary care center.
2. To assess the immediate procedural outcomes and complication profile in this cohort.

Methods: This was a record-based descriptive study conducted in the Department of Cardiology, Government Medical College, Alappuzha. Data were collected from the CTO registry for a 2-year period (November 2022 to November 2024). Patients aged ≥18 years with angiographically confirmed CTO (duration >3 months) who underwent percutaneous coronary intervention (PCI) were included. Those with severe comorbidities, uncontrolled systemic conditions, or inability to provide consent were excluded. Data were extracted on demographics, comorbidities, clinical symptoms, angiographic features, procedural success, and complications, and were entered into a master chart for descriptive statistical analysis. Results: A total of 220 patients underwent CTO angioplasty during the study period. Most patients were elderly, with 66.36% aged >60 years. Males constituted 84.09% of the cohort. Hypertension (76.36%), type 2 diabetes mellitus (86.36%), and smoking (67.27%) were the most common risk factors. Prior PCI was seen in 50.90% and previous CABG in 15.45%. The predominant presenting symptoms were dyspnea on exertion (83.18%), easy fatigability (79.09%), and effort angina (71.36%), with most in NYHA Class II. The most common clinical presentation was UA/NSTEMI (55.45%), followed by chronic stable angina (37.27%) and STEMI (7.27%). Angiographically, double vessel disease was most frequent (69.54%), and the LAD was the most commonly involved CTO vessel (52.72%), followed by LCX (39.54%) and RCA (38.18%). Procedural success was achieved in 82.72% of cases. The most frequent complication was coronary perforation (15.45%), followed by nonfatal myocardial infarctions (10.45%), arrhythmias (8.18%), and no-flow/slow-flow phenomena (8.18%). Stroke and acute kidney injury were rare (1.36% and 0.91%, respectively). All-cause and cardiac-specific mortality were low at 0.91%. No patients required emergency CABG. Conclusion: CTO angioplasty, once considered a high-risk and low-success intervention, is now feasible and effective with a high procedural success rate and low mortality. Despite the complexity of cases and comorbid burden, the outcomes reflect improved technical capabilities and procedural safety. Early recognition, appropriate case selection, and expertise are crucial for favorable outcomes.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, with an increasing burden in Bangladesh. Identifying the prevalence, risk factors, and angiographic patterns of CAD is essential for effective prevention and management. This hospital-based study aimed to assess the demographic characteristics, risk factors, severity, and treatment approaches among Bangladeshi patients with CAD. Methods: This cross-sectional study was conducted in the Department of Cardiology, Mymensingh Medical College Hospital, from November 2023 to December 2024. A total of 107 patients admitted with suspected CAD were included. Results: The study included 107 patients, with a male predominance (76.6%) and a mean age of 51.7 ± 11.3 years. Hypertension was the most prevalent risk factor (38.3%), followed by smoking (33.6%) and diabetes mellitus (22.4%). Obesity and a family history of CAD were present in 22.4% and 16.8% of cases, respectively. Among the study population, 72.0% had confirmed CAD. Single-vessel disease was the most common pattern (30.8%), followed by triple-vessel disease (22.4%) and double-vessel disease (18.7%). Percutaneous coronary intervention (PCI) was performed in 23.4% of patients, while 7.5% were recommended for coronary artery bypass grafting (CABG). Optimal medical therapy (OMT) was the primary management approach in 21.5% of cases. Conclusion: This study highlights a high burden of CAD in Bangladesh, with modifiable risk factors playing a crucial role. Early screening, lifestyle modifications, and optimal management strategies are essential to reduce the impact of CAD in this population.

Background: Air pollution is a major environmental health concern, particularly affecting lung development in adolescents. Urban populations are often more exposed to higher levels of air pollutants compared to their rural counterparts. This study aims to evaluate and compare pulmonary function in adolescents residing in urban and rural regions with varying air quality indices (AQI). Materials and Methods: A cross-sectional observational study was conducted involving 120 adolescents aged 13–18 years, with 60 participants each from urban and rural areas. Participants underwent spirometry to measure Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), and FEV1/FVC ratio. AQI levels were monitored over a 3-month period in both regions. Exclusion criteria included known respiratory illnesses, smoking, and recent infections. Statistical analysis was performed using unpaired t-tests and ANOVA. Results: The mean FEV1 among urban adolescents was 2.48 ± 0.42 L, significantly lower than the rural group (2.91 ± 0.37 L, p < 0.001). Similarly, FVC was reduced in the urban group (3.12 ± 0.45 L) compared to rural participants (3.45 ± 0.39 L, p = 0.004). The mean FEV1/FVC ratio was also lower in urban subjects (79.4%) versus rural (84.3%), indicating early signs of obstructive airway changes. Average AQI in urban areas was 186 (moderate to poor), while rural areas recorded an average AQI of 72 (good). Conclusion: Adolescents living in urban areas with higher air pollution levels demonstrate significantly reduced pulmonary function compared to their rural counterparts. These findings highlight the need for improved air quality monitoring and public health interventions to protect vulnerable age groups.

Introduction: Hypertension is a major public health issue globally, with varying prevalence across different demographics and geographical locations. This study aims to assess the prevalence and associated risk factors for hypertension in urban and rural populations to identify targeted interventions. Methods: This cross-sectional study involved 500 participants, equally divided between urban and rural settings. Data were collected through health surveys and physical examinations, focusing on hypertension status, demographic variables, lifestyle factors, and access to healthcare services. Statistical analysis included chi-square tests, t-tests, and logistic regression. Results: The prevalence of hypertension was significantly higher in rural areas (40.8%) compared to urban areas (34.8%) (p=0.045). Rural participants were older and had higher mean body mass index. Factors such as smoking and family history of hypertension were more prevalent in rural populations. Urban residents reported better healthcare access and higher engagement in health awareness programs. Lifestyle factors such as dietary salt intake and physical activity also differed significantly between the two groups. Conclusion: Hypertension prevalence is significantly influenced by geographic location, with rural populations exhibiting higher rates and associated risk factors. Differences in lifestyle behaviors and healthcare accessibility suggest the need for region-specific health policies and programs to manage and prevent hypertension effectively.