http://sorana.academicdirect.ro/pages/doc/PC2/Full-Text-CaseControlStudy.pdf

Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Global Burden of Cardiovascular Diseases Part I: General Considerations, the Epidemiologic Transition, Risk Factors, and Impact of Urbanization

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(05)67663-5.pdf

Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.

As the twentieth century draws to a close, it is clear that cardiovascular disease (CVD) has become a ubiquitous cause of morbidity and a leading contributor to mortality in most countries.1 2 The rise and recent decline of the CVD epidemic in the developed countries have been well documented.3 4 The identification of major risk factors through population-based studies and effective control strategies combining community education and targeted management of high risk individuals have contributed to the fall in CVD mortality rates (inclusive of coronary and stroke deaths) that has been observed in almost all industrialized countries. It has been estimated that during the period 1965 to 1990, CVD related mortality fell by ≈50% in Australia, Canada, France, and the United States and by 60% in Japan.1 Other parts of Western Europe reported more modest declines (20% to 25%). The decline in stroke mortality has been more marked compared with the decline in coronary mortality. In the United States, the decline in stroke mortality commenced nearly two decades earlier than the decline in coronary mortality and maintained a sharper rate of decline. During the period 1979 to 1989, the age-adjusted mortality from stroke declined, in that country, by about one third, whereas the corresponding decline in coronary mortality was 22%.4 5 In Japan, where stroke mortality outweighs coronary mortality, the impressive overall decline in CVD mortality is principally contributed by the former. The discordant trend of rising CVD mortality rates in Eastern Europe, however, is in sharp contrast to the decline in Western Europe.1 

The emergence of the CVD epidemic in the developing countries during the past two to three decades has attracted less comment and little public health response, even within these countries. It is not widely realized that at present, the developing countries …

Emerging epidemic of cardiovascular disease in developing countries

This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiological transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.

Global Burden of Cardiovascular Diseases: Part II: Variations in Cardiovascular Disease by Specific Ethnic Groups and Geographic Regions and Prevention Strategies

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(96)02507-X.pdf

Risk factors for acute myocardial infarction in Indians: a case-control study

There is sparse data on the treatment practices being followed for acute myocardial infarction at various hospitals that differ in their financial infrastructure, availability of facilities and attachment to a medical college. In this prospective observational study, we evaluated the treatment practices for acute myocardial infarction, its appropriateness based on ACC/AHA guidelines and possible influence by type of hospital and certain patient characteristics. Thrombolysis, beta-blockers and angiotensin-converting enzyme-I inhibitors were used in 674 (63%), 506 (47%) and 413 (38%) respectively of 1072 patients. However, when evaluated according to ACC/AHA guidelines, appropriate use was noted in 83 percent, 78 percent and 99.3 percent, respectively. Thrombolysis was inappropriately denied to 14.7 percent patients whereas in 2.4 percent it was used contrary to recommendations. The most common reason for ineligibility for thrombolysis was late arrival. Beta-blockers were denied to 25.1 percent patients. Decision on use of angiotensin-converting enzyme-I was appropriate in most patients. Aspirin was used in 1027 (95.8%) patients. Government hospitals were least likely to thrombolyse a patient as compared to private, industrial and voluntary hospitals; however, this difference was not seen with the use of beta-blockers and angiotensin-converting enzyme-I. Hospitals attached to medical colleges follow guidelines for use of thrombolysis and beta-blockers more closely than non-teaching hospitals. To conclude, evaluation of appropriateness of a therapeutic modality is of greater clinical significance than mere absolute use. Benefits of thrombolytic therapy can be extended by minimising pre-hospital delay; and there is scope for improved utility of beta-blockers which are cost-effective. In addition, the hospital type also has an impact on the treatment practice being followed for acute myocardial infarction.

Treatment of acute myocardial infarction: does the type of hospital make a difference? PPAMI Study Group.

OBJECTIVES Time is of prime importance in the management of acute myocardial infarction (AMI). Time to hospital admission should be minimised for maximum thrombolytic benefit. The present paper has evaluated some socio-demographic factors influencing pre hospital delay. METHODS This prospective observational study of 1,072 patients with AMI admitted to 14 hospitals in South India was done over one year. Socio-demographic factors viz. time of symptom onset, place of residence, type of transportation to hospital, distance travelled, as well as clinical and treatment details were recorded. Hospitals were grouped based on their location into metropolitan and town hospitals. RESULTS Males predominated (85%) and had AMI at a younger age than females. Most patients (74%) travelled less than 30 km to a hospital. The mean distance travelled to a town hospital was longer than that to a metropolitan hospital (24.2 km vs 21 km; p < 0.0001); however there was no significant difference in the type of transportation or time taken to reach either of the hospitals. Majority (79%) of patients arrived at a hospital within the thrombolytic window of 12 hours (mean time = 11 hours). The occurrence of a previous MI had no influence on time taken to hospital arrival, questioning the role of symptom education as an interventional strategy to reduce pre hospital delay. Patients older than 70 years and females in towns with symptom onset during the day (6 am to 6 pm) took a longer time to reach hospital. CONCLUSION Community facilities do not affect pre hospital delay. Interventions should focus on reducing decision time to call for help and the role of symptom education needs further evaluation.

Pre hospital issues in acute myocardial infarction.

Introduction: Intestinal coccidian parasites known to cause opportunistic infections have increased since the past years and are often indistinguishable from other forms of community- acquired diarrhoea, which suggests a need for proper and rapid diagnostic techniques to recover and identify the organism. Aim: To investigate if Auramine Rhodamine (AR) staining is a sensitive and time conserving staining technique in contrast to modified acid fast stain. Materials and Methods: A descriptive observational study was conducted at Nizam’s Institute of Medical Sciences, Hyderabad, India, over a period of three months (i.e., from July to September 2019). A total of 100 stool samples received by the Department of Microbiology were subjected to macroscopic and microscopic examination by saline mount, iodine mount, kinyoun acid fast stain, modified AR staining. Results: In the present study the prevalence of coccidian infections were observed to be 6%. Coccidian parasites reported were Cryptosporidium species and Cystoisospora species immunocompromised patients were found to be more prone to infections with coccidian parasites. The AR stain showed 100% agreement with modified acid fast stain. Conclusion: This study concluded that the AR stain is a rapid and better stain than kinyoun acid-fast stain for the detection of coccidian parasites.

D Savitha

Papers

Risk factors for acute myocardial infarction in Indians: a case-control study

Treatment of acute myocardial infarction: does the type of hospital make a difference? PPAMI Study Group.

Pre hospital issues in acute myocardial infarction.

Detection of Coccidian Parasites using Auramine Rhodamine Stain: A Rapid and Sensitive Tool