Patterns of smoking in Delhi and comparison of chronic respiratory morbidity among beedi and cigarette smokers

Tobacco smoking is common in developing countries including India with beedi and cigarette smoking being the main types. A community-based study carried out to study the chronic respiratory morbidity in the urban areas of Delhi was analyzed to determine the patterns of tobacco smoking and to compare the chronic respiratory morbidity among beedi and cigarette smokers. A random, stratified sample was selected from among the permanent residents, aged above 18 years, from nine clusters in Delhi. A standardized respiratory symptoms questionnaire was administered and clinical examination carried out followed by spirometry. The questionnaire included a detailed smoking history including type of smoking, number of cigarettes smoked per day and number of years the person had smoking. Chronic respiratory morbidity in beedi and cigarette smokers was measured in terms of prevalence of chronic respiratory symptoms (chronic cough, phlegm, breathlessness and wheezing) and by lung function results. It was observed that nearly 40% of adult males were current smokers. Beedi smoking was overall the commonest type of smoking in the community. Cigarette smoking was more common in the higher income groups and among the graduates and postgraduates. Beedi smoking was the main form of smoking among the lower and middle-income groups and among the illiterates and the less educated people. Very few female subjects admitted to smoking. The prevalence of symptomatics (those having one or more of chronic chest symptoms) was significantly higher in beedi smokers as compared to cigarette smokers in those smoking greater than 2.5 pack years. Prevalence of wheezing was however not significantly different. Multiple logistic regression analysis revealed type of smoking to be a significant independent determinant of occurrence of respiratory symptoms with the odds for occurrence of symptoms being 1.67 times greater in beedi smokers as compared to cigarette smokers. Lung function (FEV1/FVC and FEV1% predicted) showed significantly greater airways obstruction in beedi smokers as compared to cigarette smokers. It was concluded that the beedi smoking was as or more likely to cause clinical and functional impairment of lungs compared to cigarette smoking.     

Decreased sodium-potassium and calcium adenosine triphosphatase activity in asthma: modulation by inhaled and oral corticosteroids

The activation of both the inflammation-producing cells and the airway smooth muscle in asthma is believed to be a phenomenon dependent on the intracellular calcium. The activity of Na+ K+ ATPase and Ca2+ ATPase, enzymes responsible for regulating the intracellular calcium concentrations has been reported to be decreased in asthma. An increase in plasma lysophosphatidylcholine (LPC), which is known to be a pro-inflammatory compound and has an inhibitory effect on the two ATPases has also been reported. Corticosteroids are potent antiinflammatory drugs very effective in the treatment of asthma. The effect of long-term (12 weeks) treatment with inhaled beclomethasone dipropionate (BDP) and short-term (1 week) treatment with oral prednisolone on the activity of the two ATPases and intracellular calcium in leukocytes and plasma LPC levels was investigated. Both the treatments resulted in an improvement in lung function accompanied by an increase in the activities of the ATPases and a decrease in the intracellular calcium and LPC levels. It was concluded that increase in the activities of Na+ K+ ATPase and Ca2+ ATPase and a consequent lowering of intracellular calcium, and a lowering of plasma LPC may underlie the beneficial effect of corticosteroids in asthma.     

Knowledge, attitudes, beliefs and practices regarding measles in a rural area of Delhi

387 mothers in Mehrauli block of Delhi were interviewed regarding their knowledge, attitudes, beliefs and practices regarding measles. 98.4% enumerated one or the other symptoms, fever being the commonest. 77.5% were aware of the infectious nature and 97% had favourable attitude regarding feeding the child during measles. The commonest foodstuff given was cowmilk and khichdi. 95.1% of the respondents intended to apply local herbs on eruptions. There was a variety of local medicines for home treatment and Laung, Tulsi leaves and Kishmish being the practice in descending order of preference. 98.4% respondents favoured giving special nutritional care during the attack of measles to their children.     

Meta-Analysis: The Association Between HIV Infection and Extrapulmonary Tuberculosis

Background

Extrapulmonary tuberculosis has been an AIDS-defining condition. Individual studies that highlight the association between HIV and extrapulmonary TB are available. Our objectives were to synthesis evidence on the association between extrapulmonary tuberculosis and HIV and to explore the effective preventive measures of these two diseases.

Methods

This is a meta-analysis of observational studies reporting effect estimates on how HIV is associated with extrapulmonary tuberculosis. We searched for the eligible studies in the electronic databases using search terms related to HIV and extrapulmonary tuberculosis. Where possible, we estimated the summary odds ratios using random effects meta-analysis. We stratified analysis by the type of study design. We assessed heterogeneity of effect estimates within each group of studies was assessed using I ² test.

Results

Nineteen studies (7 case control studies and 12 cohort studies) were identified for the present study. The pooled analysis shows a significant association between HIV and extrapulmonary tuberculosis (summary odds ratio: 1.3; 95 % confidence interval (CI) 1.05–1.6; I ²: 0 %). In a subgroup analysis with two studies, a significant association was found between CD4+ count less than 100 and the incidence of extrapulmonary tuberculosis (summary OR: 1.31; 95 % CI 1.02–1.68; I ²: 0 %).

Conclusions

Findings show evidence on the association between extrapulmonary tuberculosis and HIV, based on case control studies. Further studies to understand the mechanisms of interaction of the two pathogens are recommended.     

Greek version of the General Health Questionnaire: accuracy of translation and validity.

The purpose of this study was to examine the accuracy of translation and to test the validity of the Greek version of the General Health Questionnaire (GHQ). In the translation study, the English and the Greek versions of the GHQ were administered to a sample of 50 bilingual respondents. The internal consistency, item-by-item and the subject-by-subject analysis have shown that the 2 versions are equivalent and therefore the Greek translation is highly accurate. In the validity study, 100 consecutive patients attending an internal medicine outpatient clinic completed the Greek version of the GHQ-60 and were interviewed independently using the Present State Examination (PSE). The validity of the shorter forms of the questionnaire (GHQ-30 and GHQ-28) was tested by disembedding the relevant items from the larger set. The correlations obtained between the scores of the questionnaire and the PSE ratings, as well as all the validity indices (sensitivity, specificity, positive predictive value, negative predictive value and overall misclassification rate) were quite satisfactory for all the GHQ forms, thus confirming the validity of the questionnaire in its Greek version. The best cut-off points as found by receiver-operating characteristics analysis were 11/12 for the GHQ-60, 5/6 for the GHQ-30 and 4/5 for the GHQ-28. The revised (CGHQ) scoring system for the GHQ-30 has not been proved superior to the conventional scoring method. The above results are discussed in relation to the pertinent literature and especially the studies carried out in similar settings and in countries with similar cultural backgrounds.     

Propranolol in the treatment of acute migraine attacks

The efficacy of the beta-adrenoceptor antagonist propranolol in the acute treatment of patients in attacks of either classical (migraine with aura) or common migraine (migraine without aura) headache was assessed in a double-blind placebo-controlled crossover trial with fixed doses. The trial was carried out on 25 patients. The treatment period was set at eight weeks, with the provision of shortening or lengthening it if necessary with a maximum period of seventeen weeks. A minimum of three migraine attacks were treated during each treatment period. Patients were assessed according to: the mean duration and mean severity per treatment period of migraine attacks. The secondary efficacy assessment was made on the basis of the percentage of attacks requiring escape medication per treatment period. The study, based on the t-distribution statistical model with a confidence level of 95%, showed that propranolol had no significant effect in aborting acute attacks of migraine when compared with placebo.     

Maternal mortality due to eclamptic and non-eclamptic hypertensive disorders: a challenge.

Eclamptic and non-eclamptic hypertensive disorders are responsible for high maternal and perinatal mortality, especially in developing countries. The present study was done in order to understand the trends of maternal deaths due to non-eclamptic and eclamptic hypertensive disorders by analysis of case records of women who died due to these disorders over a period of 20 years. Overall, hypertensive disorders contributed to 31% of maternal deaths, 24.7% due to eclampsia with a decreasing trend from 43% in block A to 8.8% in block E. Case fatality rate (CFR) among eclampsia decreased from 23.3% in block A to 5.7% in block E; 32.7% among ante-partum and 9.9% postpartum and 23.9% in term and 8.9% in pre-term cases. Although the contribution of hypertensive disorders to maternal mortality has reduced significantly (from 43% in block A to 29% in block E), deaths due to non-eclamptic hypertensive disorders have increased from 3% in block C to 23% in block E. Over the years, the contribution of patients<20 years of age has decreased from 8% to 2%, 32% of women who died due to eclampsia were below the age of 20 years. The most common cause of mortality in cases of pre-eclampsia was haemolysis, elevated liver enzymes, and low platelet count (HELLP) or partial HELLP syndrome (83.33%) and in eclampsia, pulmonary oedema. Even with resource constraints, mortality due to eclampsia can be reduced with appropriate and timely therapy. Evidence-based critical care is essential as even seemingly milder forms of pregnancy induced hypertension can lead to mortality.