Renuka Saha

Early and long-term results of subclavian angioplasty in aortoarteritis (Takayasu disease): comparison with atherosclerosis.

AbstractPurpose: To compare the early and long-term outcomes of subclavian artery angioplasty in patients with aortoarteritis and atherosclerosis. Methods: Sixty-one subclavian artery angioplasties were performed in 55 consecutive patients with aortoarteritis (n=32) and atherosclerosis (n=23) between 1986 and 1995. An arch aortogram followed by a selective subclavian artery angiogram was done to profile the site and extent of the lesion, its relation to the vertebral artery, and the distal circulation. Percutaneous transluminal angioplasty (PTA) was performed via the femoral route for 56 stenotic lesions and 5 total occlusions. Results: PTA was successful in 52 (92.8%) stenotic lesions and 3 (60%) total occlusions. Three patients (5.4%) had complications, that could be effectively managed nonsurgically. Compared with atherosclerosis, patients with aortoarteritis were younger (27.4±9.3 years vs 54.5±10.5 years; p<0.001), more often female (75% vs 17.4%; p<0.001), gangrene was uncommon (0% vs 17.4%; p<0.05), and diffuse involvement was seen more often (43.8% vs 4.4%; p<0.001). The luminal diameter stenoses were similar before PTA (88.6±9.7% vs 89.0±9.1%; p=NS). Higher balloon inflation pressure was required to dilate the lesions of aortoarteritis (9.9±4.6 ATM vs 5.5±1.0 ATM; p<0.001). This group had more residual stenosis (15.5±12.4% vs 8.3±9.4%; p<0.05) after PTA. There were no neurological sequelae, even in PTA of prevertebral lesions. On 3–120 months (mean 43.3±28.9 months) follow-up of 40 patients, restenosis was more often observed in patients with aortoarteritis, particularly in those with diffuse arterial narrowing. These lesions could be effectively redilated. Clinical symptoms showed marked improvement after successful angioplasty. Conclusion: Subclavian PTA is safe and can be performed as effectively in aortoarteritis as in atherosclerosis, with good long-term results. Long-term follow-up shows that it provides good symptomatic relief.

Problems Related to Menstruation and Their Effect on Daily Routine of Students of a Medical College in Delhi, India

Menstrual problems are common among young girls. These deserve careful evaluation as uncorrected menstrual problems may adversely affect the daily routine and quality of life. The aim of this article is to study the prevalence and the effect of menstrual disorders on daily routine among unmarried undergraduate medical students and their treatment-seeking behavior. Of 276 undergraduate girl students, 112 were sampled by stratified random sampling. All the consenting participants were given a pretested semistructured questionnaire to collect their responses by personal interviews. The data collected were analyzed. Premenstrual syndrome (67%) and dysmenorrhea (33%) were perceived by the study subjects as the most distressing problems associated with menstruation. The most common effect of menstrual problems on daily routine reported by the study subjects was in the form of prolonged resting hours (54%) followed by inability to study (50%). More than half (52%) of the subjects discussed their problems with their mother, and 60% of the study subjects were opted for allopathic treatment for their menstrual problems.

Awareness and Perception about Tuberculosis in the General Population of Delhi

The present study was conducted to assess awareness and perception regarding tuberculosis among the general population of Delhi. A total of 1,008 adults, selected by multistage stratified systematic sampling, were interviewed using a pre-tested proforma. The majority had heard about tuberculosis (99.1%) and most (89.2%) perceived it to be an infectious disease. The correct mode of transmission i.e. airborne (coughing / sneezing) was known to 71.8% study subjects. The majority (90.1%) knew cough as a symptom. Nearly all (98.2%) perceived Tuberculosis to be a preventable disease, citing the treatment of patients as the main-stay of preventing spread of the disease. However, responses like separation of utensils or hospitalisation of the patient to prevent the spread of the disease indicate persistence of stigma and discrimination in a small proportion of the population. There is a need to widen the scope and intensify the information and education being provided to the population based on gaps identified. Asia Pac J Public Health 2007; 19(2): 10-15.

A Study of the Impact of Tuberculosis on the Quality of Life and the Effect After Treatment With DOTS

A prospective study was conducted on 90 patients of tuberculosis at 2 directly observed treatment short course (DOTS) cum microscopy centers in an urban area of Delhi. The WHOQOL-BREF (Hindi) questionnaire was used to assess the QOL at the onset of treatment, after 3 months of treatment under DOTS, and at completion of treatment. Patients with tuberculosis had significantly lower mean scores than controls for overall QOL. The most affected domains were physical and psychological. Women scored significantly better than men in the physical and environmental domains. Overall QOL scores were lowest for category II and significantly lower for the psychological and social domains. The mean scores after treatment were significantly lower than controls for overall QOL, the social and environmental domains. The DOTS regimen improves the QOL and its domains; however, they remain significantly affected compared to the healthy controls

Seasonal variation in prevalence of hypertension: Implications for interpretation.

OBJECTIVES to study seasonal variation in prevalence of hypertension. MATERIALS AND METHODS the study was carried out in the year 2006, in Gokulpuri, an urban slum located in eastern part of Delhi. 275 females 18-40 years of age were examined in summer. Blood pressure was measured in two seasons, summer and winter. Nutritional status of each individual was assessed by BMI. RESULTS the prevalence of hypertension based on SBP was 12.72% in summer which increased to 22.22% in winter. The prevalence of hypertension, using DBP criteria increased to more than double (summer vs. winter, 11.27% vs. 26.59%, P< 0.001). Overall prevalence of hypertension (SBP ≥ 140 or DBP ≥ 90 mm of Hg) was 1.9 times during winter compared to summer (P<0.001). Greater increase in prevalence of hypertension during winter among older females and underweight as well as normal females was observed. CONCLUSION Significant increase in prevalence of hypertension during winter compared to summer indicates need for considering this factor while comparing prevalence reported in different studies as well as interpreting the surveillance data based on repeat surveys.

Seasonal variation of blood pressure in normotensive females aged 18 to 40 years in an urban slum of Delhi, India.

Season is one of the factors affecting blood pressure. The objectives of this study are to quantify the magnitude of seasonal changes in blood pressure among normotensive women aged 18 to 40 years and to find out the association of blood pressure variation between winter and summer with body mass index, temperature, humidity, day length, and salt intake. The study was carried out on 132 women, included 4 home visits during the seasons of spring, summer, autumn, and winter. Mean increase in systolic blood pressure (SBP)/diastolic blood pressure (DBP) in winter was 11.07/6.79 mm Hg during summer (P < .001). No significant relationship in blood pressure variation with change in environmental variables was observed. Mean increase in SBP/DBP in winter was more among underweight than individuals who were normal/overweight/obese (P < .05). There was significant increase in SBP/DBP during winter compared with summer. This seasonal factor should be considered while evaluating individual blood pressure and comparing community studies.

Knowledge of general public and health professionals about tetanus immunization

Objective : To study the awareness among general public and health care providers about tetanus immunization in relation to injuries, and their knowledge about tetanus immunization schedules in children, pregnant females and adults.Methods : It was a cross-sectional study done at a perfect health mela and all the government allopathic health agencies in Delhi.Results : The knowledge of tetanus immunization was poor among general public as well as health care providers. A substantial proportion of them indicated tetanus injection after every injury, which was unwarranted. The knowledge of tetanus immunization schedule for adults was poor among all categories of respondents, though it was comparatively better for pregnant females, but only 75% of doctors and 51.1 % of nursing personnel correctly knew the immunization schedule against tetanus in children.Conclusion : There is a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of tetanus are followed properly and unnecessary repeated immunizations are avoided and the same knowledge is passed on to the general public also.

Prevalence and correlates of tobacco smoking, awareness of hazards, and quitting behavior among persons aged 30 years or above in a resettlement colony of Delhi, India.

Aim: To assess the prevalence and correlates of current smoking, awareness of hazards, and quitting behavior among smokers 30 years and above. Materials and Methods: Study design: Cross-sectional; Setting: Gokulpuri, a resettlement colony in East Delhi, India; Sample size: 911, persons aged 30 years and above using systematic random sampling; Study tools: Semi-structured questionnaire. Results: Prevalence of current smoking was found to be 24.6% (95% CI 21.90 - 27.49). Majority 198 (88.4%) of current smokers smoked bidi exclusively, and on an average 13.5 bidi/cigarette were smoked per day. Multivariate analysis showed the factors associated with current smoking as male sex, advancing age, illiteracy, skilled occupation, low socio-economic status, and low BMI (P < 0.001). 64.2% were aware of the hazards of smoking. 63 (21.9%) had quit smoking in the past, majority due to the health problems. Low educational status was associated with poor hazard awareness and quitting behavior. Conclusion: Smoking is a significant problem among poor and illiterate males, shows an increasing trend with an advancing age and is directly associated with skilled occupation and low BMI. There are significant gaps in knowledge regarding hazards of smoking.

Sex hormone binding globulin in breast cancer

The present study was undertaken to determine the significance of sex hormone binding globulin, the major and specific binding protein for testosterone and estradiol, in breast cancer. Among breast cancer patients, lower serum levels of Sex hormone binding globulin and higher levels of testosterone were observed. Sex hormone binding globulin showed an inverse relationship with testosterone and total cholesterol, and a direct relation with HDL-cholesterol. By the western blot analyses, Sex hormone binding globulin was detected in all biological samples that we examined. In the breast tumor tissue sections, immuno-staining for Sex hormone binding globulin was confined in cell cytoplasm and 29% cases were positive, which showed no association with the investigated prognostic markers of breast cancer such as ER and HER-2/neu over-expression. In this study, decreased circulating levels of Sex hormone binding globulin in breast cancer patients possibly indicate higher bioavailable estrogens.