Amritha Institute of Medical science

Cochin, India

Amritha Institute of Medical science

Cochin, India
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Pandey R.M.,All India Institute of Medical Sciences | Agrawal A.,University of Rajasthan | Misra A.,Fortis Rajan Dhall Hospital | Misra A.,Obesity and Cholesterol Foundation | And 8 more authors.
Indian Heart Journal | Year: 2013

Background & objectives: There is poor knowledge and behaviors regarding chronic diseases related nutritional and lifestyle factors among women in low income countries. To evaluate efficacy of a multilevel population-based intervention in improving knowledge and practices for related factors we performed a study in India. Methods: Population based study among women 35-70 years was performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4624 (rural 2616, urban 2008) of eligible 8000 women (58%). Demographic details, medical history, diet, physical activity and anthropometry were recorded and blood hemoglobin, glucose and total cholesterol determined. Knowledge and behaviors regarding diet in chronic diseases were inquired in a randomly selected 100 women at each site (n = 900). A systematic multilevel population based intervention (using posters, handouts, street plays, public lectures, group lectures and focused group discussions) was administered over 6 months at each site. The questionnaire was re-administered at the end in random 100 women (n = 900) and differences determined. Descriptive statistics are reported. Comparison of parameters before and after intervention was assessed using Mann Whitney test. Results: Prevalence (%) of chronic disease related lifestyles and risk factors in rural/urban women, respectively, was illiteracy in 63.6/29.4, smoking/tobacco use 39.3/18.9, high fat intake 93.6/93.4, high salt intake 18.2/12.6, low physical activity 59.5/70.2, overweight/obesity 22.5/45.6, truncal obesity 13.0/44.3, hypertension 31.6/48.2, hypercholesterolemia 13.5/27.7, and diabetes in 4.3/15.1 percent. Composite chronic diseases knowledge at baseline vs after intervention increased significantly in overall (32.0 vs 62.0), rural (29.0 vs 63.5) and urban (39.5 vs 60.5) groups (p < 0.001). Significant increase in knowledge regarding diet in hypertension, diabetes, heart disease and anemia as well as importance of dietary proteins, fats, fibres and fruits was observed (p < 0.001). There was insignificant change in most of the practices regarding intake of low fat, high protein, high fibre diet except sieving the flour which declined significantly (80.1 vs 53.6, p < 0.001). Conclusions: A short-term multilevel population-wide intervention among women in rural and urban locations in India increased chronic disease knowledge but failed to influence practices. © 2012, Cardiological Society of India. All rights reserved.


Gupta R.,Fortis Escorts Hospital | Pandey R.M.,All India Institute of Medical Sciences | Misra A.,Fortis Rajan Dhall Hospital | Agrawal A.,Fortis Escorts Hospital | And 10 more authors.
Journal of Human Hypertension | Year: 2012

Hypertension is an important public health problem in India. To determine its prevalence, awareness, treatment and control among women, we performed a nationwide study. Population-based studies among women aged 35-70 years were performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4608 (rural 2604 and urban 2004) of the targeted 8000 (57%). Demographic details, medical history, diet, physical activity, anthropometry and blood pressure (BP) were recorded. Descriptive statistics are reported. Logistic regression was performed to determine the association of hypertension and its awareness, treatment and control with socioeconomic factors. Age-adjusted prevalence of hypertension (known or BP≤140/≥90 mm Hg) was observed in 1672 women (39.2%) (rural 746, 31.5%; urban 926, 48.2%). Significant determinants of hypertension were urban location, greater literacy, high dietary fat, low fibre intake, obesity and truncal obesity (P0.01). Hypertension awareness was noted in 727 women (42.8%), more in urban (529, 56.8%) than in rural (198, 24.6%). Of these, 38.6% of the women were on treatment (urban 35.7, rural 46.5) and of those treated, controlled blood pressure (140 and 90 mm Hg) was observed in 21.5% (urban 28.3 vs 10.2). Among hypertensive subjects, treatment was noted in 18.3% (rural 13.1, urban 22.5) and control in 3.9% (rural 1.3, urban 5.9). A significant determinant of low awareness, treatment and control was rural location (multivariate-adjusted P0.05). There is a high prevalence of hypertension in middle-aged Asian Indian women. Very low awareness, treatment and control status are observed. © 2012 Macmillan Publishers Limited.


Pandey R.M.,All India Institute of Medical Sciences | Gupta R.,Monilek Hospital | Misra A.,Fortis Rajan Dhall Hospital | Misra P.,All India Institute of Medical Sciences | And 8 more authors.
International Journal of Cardiology | Year: 2013

Objectives: Cardiovascular diseases (CVD) are the most important cause of death amongst middle-aged Indian women. To determine prevalence of CVD risk factors and their determinants we performed a nationwide study. Methods: Population based studies amongst women 35-70 years were performed in four urban and five rural locations in India. Location based stratified sampling was performed and we enrolled 4624 (rural 2616, urban 2008) of eligible 8000 women (58%). Demographic details, medical history, diet, physical activity and anthropometry were recorded using standardised techniques. Blood haemoglobin, glucose and total cholesterol were determined. Risk factors were diagnosed using current guidelines. Descriptive statistics are reported. Stepwise multivariate logistic regression was performed to identify determinants of urban-rural differences. Results: In urban women mean body mass index (BMI), waist circumference, waist-hip ratio (WHR), systolic BP, haemoglobin, fasting glucose and cholesterol were significantly greater (p < 0.01). Age-adjusted prevalence of risk factors (%) in urban vs rural was of obesity BMI ≥ 25 kg/m2 (45.6 vs 22.5), truncal obesity WHR > 0.9 (44.3 vs 13.0), hypertension (37.5 vs 29.3), hypercholesterolemia ≥ 200 mg/dl (27.7 vs 13.5), and diabetes (15.1 vs 4.3) greater whilst any tobacco use (19.6 vs 41.6) or smoking lower. Significant determinants of urban-rural differences were greater income and literacy, dietary fats, low physical activity, obesity and truncal obesity (p < 0.01). Conclusions: Greater prevalence of CVD risk factors in urban middle-aged women is explained by greater income and literacy, dietary fat, low physical activity and obesity. © 2011 Elsevier Ireland Ltd.


Balachandran L.,Amritha institute of Medical science | Vaswani P.R.,Madinat Zayed Hospital
Journal of Clinical and Diagnostic Research | Year: 2014

Objective: The purpose of this study was to determine the outcome of pregnancy in women with previous one cesarean section in relation to vaginal delivery and maternal and perinatal complications. It also aimed at identifying the factors, which can influence the outcome of trial of scar (TOS). Materials and Methods: A retrospective analysis of medical records of 151 women with previous one cesarean section who delivered at the Mafraq Hospital, Abu Dhabi between January-August 2011was carried out. Those women with previous classical cesarean section and those with extreme prematurity were excluded. The collected data were analyzed using SPSS software version 20. Continuous and categorical data were presented in the form of mean, standard deviation and percentage, while proportions were analyzed using the chi-square test. A p-value ≤0.05 was considered statistically significant. Results: Of the 151 women, 115 were candidates for TOS. Of them, 96 (83.47%) had vaginal birth after cesarean (VBAC) and 19 (16.5%) had a repeat cesarean section. There were four cases of primary postpartum hemorrhage (PPH) and two cases of scar dehiscence in the study group. No significant perinatal morbidity was observed. VBAC rate was significantly more in women who had prior vaginal deliveries, especially in those with previous VBAC. Conclusion: In carefully selected cases, trial of labor (TOL) after a prior cesarean is safe and often successful. A prior vaginal delivery, particularly, a prior VBAC are associated with a higher rate of successful TOL.


Gupta R.,Fortis Escorts Hospital | Gupta R.,University of Rajasthan | Agrawal A.,University of Rajasthan | Misra A.,Foundation Medicine | And 11 more authors.
Journal of Epidemiology and Community Health | Year: 2012

Objective The authors studied the influence of migration of husband on cardiovascular risk factors in Asian Indian women. Methods Population-based studies in women aged 35e70 years were performed in four urban and five rural locations. 4608 (rural 2604 and urban 2004) of the targeted 8000 (57%) were enrolled. Demographic details, lifestyle factors, anthropometry, fasting glucose and cholesterol were measured. Multivariate logistic and quadratic regression was performed to compare influence of migration and its duration on prevalence of risk factors. Results Details of migration were available in 4573 women (rural 2267, ruraleurban migrants 455, urban 1552 and urbanerural migrants 299). Majority were married, and illiteracy was high. Median (interquartile) duration of residence in urban locations among ruraleurban migrants was 9 (4e18) years and in rural areas for urbanerural migrants 23 (18e30) years. In rural, ruraleurban migrants, urban and urbanerural migrants, age-adjusted prevalence (%) of risk factors was tobacco use 41.9, 22.7, 18.8 and 38.1; sedentary lifestyle 69.7, 82.0, 79.9 and 74.6; high-fat diet 33.3, 54.2, 66.1 and 61.1; overweight 21.3, 42.7, 46.3 and 29.7; large waist 8.5, 38.5, 29.2 and 29.2; hypertension 30.4, 49.4, 47.7 and 38.4; hypercholesterolaemia 14.4, 31.3, 26.6 and 9.1 and diabetes 3.9, 15.8, 14.9 and 8.4, respectively (p<0.001). In ruraleurban migrants, there was a significant correlation of duration of migration with waist size, waist-to-hip ratio and systolic blood pressure (quadratic regression, p<0.001). Association of risk factors with migration remained significant, though attenuated, after adjustment for socioeconomic, lifestyle and obesity variables (logistic regression, p<0.01). Conclusions Compared with rural women, ruraleurban migrants and urban have significantly greater cardiometabolic risk factors. Prevalence is lower in urbanerural migrants. There is significant correlation of duration of migration with obesity and blood pressure. Differences are attenuated after adjusting for social and lifestyle variables.


Vijayalaxmi M.K.,Fr Muller Medical College | Palatty P.L.,Kasturba Medical College | Bhat P.,Ajshetty Medical College | Dinesh M.,Amritha Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2012

This study compared the adverse drug reaction (ADR) profile in various anti-cancer regimens in 55 patients who attended a tertiary care centre. The adverse drug reactions which are caused by anticancer agents are common and they may be enhanced when the drugs are used in combinations. The cases which conformed to the inclusion criteriae were selected and the details were noted in a proforma, which were then statistically analyzed. The results which were obtained, showed that the ADRs were common, but that they occurred in a similar frequency as in other study groups and that the severity grade was low. The counter measures to tackle the adverse reactions were also effective, leading to a hundred percent survival through the six cycles and the two year survival, which in itself spoke volumes about the ADRs. These findings were in tune with the findings of various researchers in the field of anti cancer toxicity profiles. The incidence of the neurotoxicity, the dermatological adverse effects and other miscellaneous ADRs was frequent, but not of high severity.


Reshma K.,Manipal University India | Rao A.V.,KS Hegde Institute of Medical science | Dinesh M.,Amritha Institute of Medical science | Vasudevan D.M.,Amritha Institute of Medical science
International Journal of Pharma and Bio Sciences | Year: 2012

Radiosensitisation influences the enzymes of free radical metabolism.These enzymes are also a part of the respiratory burst mechanisms. Withaferin,an active component obtained from the dried root extracts of withania somnifera(ashwagandha),showed radiosensitising effects in animals. Hence, a study of the respiratory burst enzymes namely NADPH oxidase,Myeloperoxidase, Glutathione,Glutathione peroxidase,Glucose 6 phosphate dehydrogenase and Superoxide dismutase were undertaken in leukocytes of patients with carcinoma of uterine cervix, which would perhaps aid in the understanding of radiosensitising mechanisms of Withaferin and increase the therapeutic outcome in cancer patients. Blood samples were collected from stage IIIB carcinoma of uterine cervix patients(n=20), before starting treatment(baseline),after 15 days and after 30 days of treatment with RT and Withaferin. Age and sex matched controls(n=25)were also considered for comparison. A significant decrease in NADPH oxidase was observed in baseline samples of cancer patients when compared to controls. Except for this variation, there was no change in the activities of other enzymes, when cancer patients were compared to controls or when baseline values were compared with that of follow up samples, in case of patients. This study therefore implies that radiosensitising actions of withaferin may not be mediated through free radical metabolism.


Sebastian S.,Christian Medical College | Nair P.G.,Amritha Institute of Medical science | Thomas P.,Christian Medical College | Tyagi A.K.,Christian Medical College
Indian Journal of Otolaryngology and Head and Neck Surgery | Year: 2014

To determine the type, severity and manifestation of dysphagia in patients with neurogenic etiology. Clinical documentation was done on the different etiologies, its manifestation, assessment findings and management strategies taken for patients with neurogenic oropharyngeal dysphagia who were referred for assessment and management of dysphagia over a period of three months in a tertiary care teaching hospital. Flexible endoscopic examination was done in all the patients. The severity of dysphagia in these patients were graded based on Gugging Swallowing Screen (GUSS). A total of 53 patients with neurogenic oropharyngeal dysphagia were evaluated by an otolaryngologist and a speech language pathologist over a period of three months. The grading of severity based on GUSS for these patients were done. There were 30 patients with recurrent laryngeal nerve injury due to various etiologies, one patient with Neurofibroma-vestibular schwanoma who underwent surgical excision, 16 patients with stroke, two patients with traumatic brain injury, two patients with Parkinsonism and two patients with myasthenia gravis. The manifestation of dysphagia was mainly in the form of prolonged masticatory time, oral transit time, and increased number of swallows required for each bolus, cricopharyngeal spasms and aspiration. Among the dysphagia patients with neurogenic etiology, dysphagia is manifested with a gradual onset and is found to have a progressive course in degenerative disorders. Morbidity and mortality may be reduced with early identification and management of neurogenic dysphagia. © 2014, Association of Otolaryngologists of India.

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