Trends in hypertension prevalence, awareness, treatment, and control: an 8-year follow-up study from rural North India

Hypertension is a major contributor to global CVD burden. LMICs including India is challenged with rising hypertension prevalence, yet limited studies are available on temporal change and incidence among community-cohorts. This study aimed to describe trends in hypertension prevalence, awareness, treatment, and control over 8 years among a rural community-cohort from Haryana, India. The study also lends towards an analysis of incidence. Adults ≥ 30 years (N = 1542) recruited during baseline cross-sectional study between 2011 and 2014 were followed up after a median 8.1 years. At endline, demographic/lifestyle characteristics and blood pressure were re-examined. Overall median SBP significantly increased from 120 mmHg at baseline to 125.5 mmHg at endline (p < 0.001), while hypertension prevalence increased from 34.4% (95% CI 32.0-36.9) to 40.4% (95% CI 37.5-43.4) (p = 0.002). Age-standardized hypertension incidence was 30.2% (95% CI 26.7-35.2) over 8 years. Among hypertensive group, awareness, treatment, and control increased from 9.6, 8.8 and 5.0% to 31.8, 27.3 and 9.6% (p < 0.05), respectively. Increasing trend in SBP and hypertension prevalence was observed as the cohort ages. This increase is supported by the high incidence of hypertension. Nevertheless, our study highlights positive trends in hypertension care cascade but poor control, suggesting that this trend may not be adequately impactful to reduce hypertension burden.

Incidence and determinants of hysterectomy among North Indian women: An 8-year follow-up study

Background

Despite indications of a rapid increase in the number of hysterectomies performed in India, very few studies have methodically investigated the rate and determinants of the incidence of hysterectomy. The present study aims to estimate the rate of incidence of hysterectomy and identify predictors/determinants of incident hysterectomy in a cohort of North Indian women.

Methods

In the present study, a cohort of 1,009 ever-married North Indian women (aged 30-75 years) was followed up after a median of 8.11 years. Those hysterectomized at the baseline (63) were excluded; and of the rest 946 participants, 702 (74.2%) could be successfully followed-up. During the baseline assessment, data about sociodemographic variables, reproductive history, menopausal status, physiological health, and selected blood biochemicals were collected. During the end-line assessment, data about sociodemographic variables, current menopausal status, and incident hysterectomy were recorded.

Results

The overall rate of incidence of hysterectomy was found to be 11.59 per 1,000 women-years, in the study population. Interestingly, the incidence rates were found to be similar among pre- and post-menopausal women. Further, while late age at menarche was found to be negatively associated with incident hysterectomy, folate repletion and high triglyceride (TG) at the baseline were found to be positively associated.

Conclusions

High rate of incident hysterectomy in the studied population points toward the huge burden of gynecological morbidity and the unavailability of non-invasive protocols. Such a situation warrants immediate policy intervention. Further, maintaining TG and folate within normal physiological ranges may be beneficial in gynecological ailments necessitating hysterectomy.

Association of air pollution and homocysteine with global DNA methylation: A population-based study from North India

BACKGROUND

Anthropogenic air pollution has been implicated in aberrant changes of DNA methylation and homocysteine increase (>15μM/L). Folate (<3 ng/mL) and vitamin B12 (<220 pg/mL) deficiencies also reduce global DNA methylation via homocysteine increase. Although B-vitamin supplements can attenuate epigenetic effects of air pollution but such understanding in population-specific studies are lacking. Hence, the present study aims to understand the role of air pollution, homocysteine, and nutritional deficiencies on methylation.

METHODS

We examined cross-sectionally, homocysteine, folate, vitamin B12 (chemiluminescence) and global DNA methylation (colorimetric ELISA Assay) among 274 and 270 individuals from low- and high- polluted areas, respectively, from a single Mendelian population. Global DNA methylation results were obtained on 254 and 258 samples from low- and high- polluted areas, respectively.

RESULTS

Significant decline in median global DNA methylation was seen as a result of air pollution [high-0.84 (0.37-1.97) vs. low-0.96 (0.45-2.75), p = 0.01]. High homocysteine in combination with air pollution significantly reduced global DNA methylation [high-0.71 (0.34-1.90) vs. low-0.93 (0.45-3.00), p = 0.003]. Folate deficient individuals in high polluted areas [high-0.70 (0.37-1.29) vs. low-1.21 (0.45-3.65)] showed significantly reduced global methylation levels (p = 0.007). In low polluted areas, despite folate deficiency, if normal vitamin B12 levels were maintained, global DNA methylation levels improved significantly [2.03 (0.60-5.24), p = 0.007]. Conversely, in high polluted areas despite vitamin B12 deficiency, if normal folate status was maintained, global DNA methylation status improved significantly [0.91 (0.36-1.63)] compared to vitamin B12 normal individuals [0.54 (0.26-1.13), p = 0.04].

CONCLUSIONS

High homocysteine may aggravate the effects of air pollution on DNA methylation. Vitamin B12 in low-polluted and folate in high-polluted areas may be strong determinants for changes in DNA methylation levels. The effect of air pollution on methylation levels may be reduced through inclusion of dietary or supplemented B-vitamins. This may serve as public level approach in natural settings to prevent metabolic adversities at community level.

Transcultural psychiatry: Comparison of eastern and western culture and their influence on mental health and its treatment

Introduction

In a globalizing world, the need for humans to understand one another is fundamental. Transcultural Psychiatry aims to bridge the differences due to culture, norms and values between doctors and patients.

Objectives

To study the beliefs of Eastern and Western populations on the subject of religion, the paranormal and its relation to mental health.

Methods

The study was conducted targeting citizens of Eastern and Western countries (target sample size 200). A survey and 2 case studies were distributed, aimed to determine respondent’s level of belief in cultural superstitions and practices, views on mental disorders and opinions on treatment. A chi-square statistical test (significance set at ≤0.05) was performed to test validity.

Results

are tabulated in Table 1. In the case studies, P-value =4.68x10-6 proves a strong relationship between East/West populations and their viewpoints on mental illness vs. possession. There is a strong relationship (p=3.37x10-5) between respondents’ beliefs in spiritual healing and its effectiveness in treating mental illness.Table 1EastWestTotal respondents (226)58%42%Identified as religious74%26%Strong belief in paranormal85%15%Effectiveness of spiritual healing55%45%Preferred methods of treatmentMental health professionals54%46%Religious healer/psychic90%10%

Conclusions

The study revealed that Eastern populations are far more superstitious and religious than their Western counterparts, and also have higher belief in the effectiveness of spiritual healing to treat mental disorders. This difference demonstrates the importance of integrating culture into diagnosis and treatment of mental illnesses, and further explore methods for more inclusive treatment plans.

Estimation of postmortem death interval from autopsied tongue tissue: A cross-sectional study

Context:

Estimation of time since death is the preliminary step in any postmortem examination. Although there are various physiological methods to conclude the postmortem, interval histological changes can be applied to obtain precision. However, the utility of oral tissues for such an event is still evolving.

Aims:

The present study was conducted to assess the efficacy of postmortem histological changes that occur in tongue to conclude the postmortem interval (PMI).

Materials and Methods:

After obtaining institutional human ethical committee, tongue tissue was collected for during routine autopsy procedure. The study comprised twelve autopsied tongue tissues. The tissue specimens were subjected to routine laboratory tissue processing procedure and the histological changes were evaluated.

Conclusion:

This is the first study of this kind in the scientific literature to explore the tongue tissue to estimate the PMI. There were definite changes in the epithelium and the connective tissue of the tongue, and these features were highly remarkable at various postmortem time intervals.

Enzymatic antioxidants and its role in oral diseases

Antioxidants are substances that when present at very low concentration inhibits the oxidation of a molecule. It has the capacity to nullify the ill effects of oxidation caused by free radicals in the living organisms. The unpaired electrons of these free radicals are highly reactive and neutralize the harmful reactions of human metabolism. Protection of the body against free radicals is provided by some enzymes which come under a distinctive group, concerned solely with the detoxification of these radicals. Superoxide dismutase (SOD), glutathione peroxidase (GPX) and catalase are the key enzymatic antioxidants of this defense system by which the free radicals that are produced during metabolic reactions are removed. This review highlights the mechanism of action of enzymatic antioxidants SOD, GPX and catalase and its role in oral disease.

Molecular predictors in the early diagnosis of oral cancer

Human beings are being subjected to a variety of disease processes, a majority of which can be cured. However, cancer remains an endangering disease that affects various body parts. Though cancers can be prevented by various therapeutic modalities, the patient survival and the prognosis are questionable, as they are detected at very late stages. The aim of improving the prognosis lies in an early detection of the cancer, which can be brought about by an analysis of the changes in the cellular biomolecules.