Medicine and Health Sciences Commons^™

Evaluating The Effect Of Maternal Non-Communicable Disease On Adverse Pregnancy Outcomes And Birthweight In Pakistan, A Facility Based Retrospective Cohort Study, Esther Wainwright, Sheikh Irfan Ahmed, Rahat Qureshi, Sana Yousuf, Raheela Khan, Matthew Elmes

Department of Obstetrics & Gynaecology

Non-communicable diseases (NCDs) claim 74% of global lives, disproportionately affecting lower and middle-income countries like Pakistan. NCDs may increase the risk of preterm birth (PTB), caesarean section (CS), and low birthweight. This study aims to determine whether the high prevalence of NCDs in Pakistan play a role in the high rates of preterm births, and CS. This retrospective cohort study from Aga Khan University Hospital, Pakistan, investigated effects of pre-existing NCDs on pregnancy outcomes of 817 pregnant women. Medical records were used to generate odds ratios for the risk of PTB, labour outcome and birthweight in women with type 1 …

Social Determinants Of Health And Disparities In Hypertension And Cardiovascular Diseases, Abhishek Chaturvedi, Anqi Zhu, Naga Vaishnav Gadela, Dorairaj Prabhakaran, Tazeen Jafar

Department of Medicine

High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual's birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD …

Stop-Bang Questionnaire For Screening Obstructive Sleep Apnea Syndrome Among Hypertensive Patients In Kenya, Salim Abdallah Salim, Jasmit Shah, Jumaa Bwika, Sayed Karar

Internal Medicine, East Africa

Introduction: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause cessation of airflow. There is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). The study aimed to describe the prevalence and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya.

Methods: This cross-sectional study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Two hundred and fifty-one hypertensive patients were screened for OSA risk using the STOP-Bang questionnaire (SBQ). Patients with a SBQ …

Stop-Bang Questionnaire For Screening Obstructive Sleep Apnea Syndrome Among Hypertensive Patients In Kenya, Salim Abdallah, Jasmit Shah, Jumaa Bwika, Sayed Karar

Internal Medicine, East Africa

Introduction: Obstructive sleep apnea (OSA) is a type of breathing problem during sleep caused by the blockage of the upper airway, which can cause cessation of airflow. There is limited research on the prevalence of OSA in hypertensive patients in sub-Saharan Africa (SSA). The study aimed to describe the prevalence and clinical characteristics of OSA among hypertensive patients at a tertiary hospital in Nairobi, Kenya.

Methods: This cross-sectional study was conducted at the Aga Khan University Hospital in Nairobi, Kenya. Two hundred and fifty-one hypertensive patients were screened for OSA risk using the STOP-Bang questionnaire (SBQ). Patients with a SBQ …

Ambient Temperature During Pregnancy And Risk Of Maternal Hypertensive Disorders: A Time-To-Event Study In Johannesburg, South Africa, Chérie Part, Jean Le Roux, Matthew Chersichb, Shobna Sawry, Véronique Filippi, Nathalie Roos, Lee Fairlie, Britt Nakstad, Jeroen De Bont, Stanley Luchters

Institute for Human Development

Hypertensive disorders in pregnancy are a leading cause of maternal and perinatal mortality and morbidity. We evaluate the effects of ambient temperature on risk of maternal hypertensive disorders throughout pregnancy. We used birth register data for all singleton births (22–43 weeks' gestation) recorded at a tertiary-level hospital in Johannesburg, South Africa, between July 2017–June 2018. Time-to-event analysis was combined with distributed lag non-linear models to examine the effects of mean weekly temperature, from conception to birth, on risk of (i) high blood pressure, hypertension, or gestational hypertension, and (ii) pre-eclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, low platelets). Low …

Heterogeneity In The Prevalence Of Premature Hypertension Among Asian American Populations Compared With White Individuals: A National Health Interview Survey Study, Sina Kianoush, Mahmoud Al Rifai, Anwar T. Merchant, Xiaoming Jia, Zainab Samad, Aneil Bhalla, Ayesha Khan, Dongshan Zhu, Salim S. Virani

Section of Cardiology

Background: Differences in prevalence of risk factors such as hypertension may explain heterogeneity in cardiovascular risk across Asian American populations.
Methods: We used National Health Interview Survey (NHIS) data from 2006 to 2018 among White, Chinese, Asian Indian, Filipino, and 'other Asians' (Japanese, Korean, and Vietnamese). Unadjusted and adjusted odds ratios (aOR) with 95% confidence intervals were reported using logistic regression models for the association between race and self-reported premature hypertension (age old). Models were adjusted for sex, education, body mass index, smoking status, diabetes, and coronary heart disease.
Results: We studied 99,864 participants with history of hypertension (mean age, …

Hypertension In Women: A South-Asian Perspective, Fatima Farrukh, Amin Abbasi, Misbah Jawed, Aysha Almas, Tazeen Jafar, Salim S. Virani, Zainab Samad

Medical College Documents

Introduction: Hypertension is an important contributor to cardiovascular disease related morbidity and mortality. Despite the magnitude of its negative impact on cardiovascular outcomes, treatment and control of hypertension remain suboptimal in both men and women.
Materials and methods: Numerous databases, i.e., PubMed, ScienceDirect, etc., were searched using keywords to identify relevant studies to our narrative review. The findings from the most pertinent articles were summarized and integrated into our narrative review on hypertension in women.
Results: The pathophysiology of essential hypertension is still being delineated in both men and women; there are multiple sex specific factors in association with the …

Potential Impact Of 2017 American College Of Cardiology/American Heart Association Hypertension Guideline On Contemporary Practice: A Cross-Sectional Analysis From Ncdr Pinnacle Registry, Aliza Hussain, Salim S. Virani, Luke Zheng, Ty J. Gluckman, William B. Borden, Frederick A. Masoudi, Thomas M. Maddox

Office of the Provost

Background Clinical implications of change in the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the diagnosis and management of hypertension, compared with recommendations by 2014 expert panel and Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), are not known. Methods and Results Using data from the NCDR (National Cardiovascular Data Registry) PINNACLE (Practice Innovation and Clinical Excellence) Registry (January 2013-Decemver 2016), we compared the proportion and clinical characteristics of patients seen in cardiology practices diagnosed with hypertension, recommended antihypertensive treatment, and achieving blood pressure (BP) goals …

Hypertension Pharmacological Treatment In Adults: A World Health Organization Guideline Executive Summary, Akram Al-Makki, Donald Dipette, Paul K. Whelton, M Hassan Murad, Reem A. Mustaf, Shrish Acharya, Hind Mamoun Beheiry, Beatriz Champagne, Kenneth Connell, Unab I. Khan

Department of Family Medicine

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

Inspire : Vol 4, Issue 6, Department Of Medicine

INSPIRE

Content

• Message from the Chair
• Medicine at National and International Forums
• In-depth- feature Visiting Faculty Dr Ghazala Sadiq
• Featured Faculty: Dr. Talha Shahzad “...Be empathetic to your patients, work hard with honesty and maintain appropriate balance between your professional and family life…”
• Publications

Acuity Level Of Care As A Predictor Of Case Fatality And Prolonged Hospital Stay In Patients With Covid-19: A Hospital-Based Observational Follow-Up Study From Pakistan, Aysha Almas, Zain Mushtaq, Jette Moller

Section of Internal Medicine

Objectives: To determine if there is an association between acuity level of care (ALC), case fatality and length of stay in patients admitted to hospital due to COVID-19.
Design: A hospital-based observational follow-up study.
Setting: Internal Medicine Service of the Aga Khan University Hospital, Pakistan, from 26 February 2020 to 30 June 2020.
Participants: Adult patients with confirmed COVID-19, aged ≥18 years.
Methods: ALC was categorised into low, intermediate and high level and patients were triaged using the standard emergency severity illness score. All patients were followed until the end of hospital admission for the outcome of case fatality and …

Economic And Cost-Effectiveness Analysis Of The Community-Level Interventions For Pre-Eclampsia (Clip) Trials In India, Pakistan And Mozambique, Jeffrey N. Bone, Asif R. Khowaja, Marianne Vidler, Beth A. Payne, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Ashalata A. Mallapur, Khatia Munguambe, Rahat Qureshi, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: The Community-Level Interventions for Pre-eclampsia (CLIP) trials (NCT01911494) in India, Pakistan and Mozambique (February 2014-2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-eclampsia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency.
Methods: Included were all women enrolled in the three …

Levels And Predictors Of Self-Care Among Patients With Hypertension In Pakistan, Khairulnissa Ajani, Ambreen Gowani, Raisa B. Gul, Pammla Petrucka

School of Nursing & Midwifery

Background: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan.
Methods: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban …

Hypertension Guidelines And Coronary Artery Calcification Among South Asians: Results From Masala And Mesa, Jaideep Patel, Anurag Mehta, Mahmoud Al Rifai, Michael J. Blaha, Khurram Nasir, John W. Mcevoy, Ambarish Pandey, Alka M. Kanaya, Namratha R. Kandula, Salim S. Virani

Office of the Provost

Untreated hypertension may contribute to increased atherosclerotic cardiovascular disease (ASCVD) risk in South Asians (SA). We assessed HTN prevalence among untreated adults free of baseline ASCVD from the MASALA & MESA studies. The proportion of participants who received discordant recommendations regarding antihypertensive pharmacotherapy use by the 2017-ACC/AHA and JNC7 Guidelines across CAC score categories in each race/ethnic group was calculated. Compared with untreated MESA participants (n = 3896), untreated SA (n = 445) were younger (55±8 versus 59±10 years), had higher DBP (73±10 versus 70±10 mmHg), total cholesterol (199±34 versus 196±34 mg/dL), statin use (16% versus 9%) and …

Frequency Of Intraoperative Hypotension After The Induction Of Anesthesia In Hypertensive Patients With Preoperative Angiotensin-Converting Enzyme Inhibitors, Fahad Salim, Fazal Hameed Khan, Muhammad Nasir, Rashid Ali, Ayesha Iqbal, Amir Raza

Department of Anaesthesia

Introduction: The renin-angiotensin-aldosterone system (RAAS) is an important target in the treatment of hypertension. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II. ACE inhibitors not only treat hypertension but also decrease morbidity and mortality in heart failure patients and in patients with acute myocardial infarction. The discontinuation of ACE inhibitors before the surgery is still controversial. To assess the current magnitude of the problem in our population, we aimed to conduct this study, which evaluated the frequency of intraoperative hypotension after the induction of anesthesia in controlled hypertensive patients with preoperative ACE inhibitors.
Material and …

The Community-Level Interventions For Pre-Eclampsia (Clip) Cluster Randomised Trials In Mozambique, Pakistan, And India: An Individual Participant-Level Meta-Analysis, Peter Von Dadelszen, Zulfiqar Ahmed Bhutta, Sumedha Sharma, Jeffrey Bone, Joel Singer, Hubert Wong, Mrutyunjaya B. Bellad, Shivaprasad S. Goudar, Tang Lee, Rahat Qureshi, Clip Trials Working Group

Woman and Child Health

Background: To overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes, we aimed to reduce all-cause adverse outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries.
Methods: In this individual participant-level meta-analysis, we de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014-17. Consenting pregnant women, aged 12-49 years, were recruited in their homes. Clusters, defined by local administrative units, were randomly assigned (1:1) to intervention or control groups. The control groups continued local standard of …

What Factors Shape Doctors’ Trustworthiness? Patients’ Perspectives In The Context Of Hypertension Care In Rural Tanzania, Kahabi Isangula, Holly Seale, Rohan Jayasuriya, Tumaini M. Nyamhanga, Niamh Stephenson

School of Nursing & Midwifery, East Africa

Introduction: There is increasing evidence that improving patient trust in doctors can improve patients’ use of healthcare services, compliance and continuing engagement with care –particularly for chronic diseases. Consequently, much of the current literature on trust in therapeutic relationships focuses on factors shaping doctors’ trustworthiness. However, few studies on this issue have been conducted among rural populations in low-income Africa, where health service delivery, cultural norms and patient expectations differ from those in high-income countries. This study examined patients’ perspectives of factors that shape doctors’ trustworthiness in rural Tanzania in the context of hypertension care.

Methods: A qualitative inquiry using …

Prevalence Of Hypertension And Its Risk Factors Among Cotton Textile Workers In Low- And Middle-Income Countries: A Protocol For A Systematic Review, Naureen Akber Ali, Anam Shahil Feroz

School of Nursing & Midwifery

Background: Cotton workers are exposed to various hazards in the textile industry that might result in different ailments including hypertension (HTN). However, few attempts have been made to systematically review the prevalence of hypertension and its risk factor among cotton textile workers in low-and middle-income countries (LMICs). The objective of this study will be to evaluate the prevalence of hypertension and its risk factors among adult cotton textile workers in low- and middle-income countries.
Methods: We designed and registered a study protocol for a systematic review of descriptive epidemiology data. We will include observational studies (e.g., cross-sectional, cohort, surveys) on …

Association Of Dairy Consumption With Metabolic Syndrome, Hypertension And Diabetes In 147 812 Individuals From 21 Countries, Balaji Bhavadharini, Mahshid Dehghan, Andrew Mente, Sumathy Rangarajan, Patrick Sheridan, Viswanathan Mohan, Romaina Iqbal, Rajeev Gupta, Scott Lear, Edelweiss Wentzel-Viljoen

Community Health Sciences

Objective: Our aims were to assess the association of dairy intake with prevalence of metabolic syndrome (MetS) (cross-sectionally) and with incident hypertension and incident diabetes (prospectively) in a large multinational cohort study.
Methods: The Prospective Urban Rural Epidemiology (PURE) study is a prospective epidemiological study of individuals aged 35 and 70 years from 21 countries on five continents, with a median follow-up of 9.1 years. In the cross-sectional analyses, we assessed the association of dairy intake with prevalent MetS and its components among individuals with information on the five MetS components (n=112 922). For the prospective analyses, we …

Hypertension As A Reason For Cancellation Of Elective Surgical Cases On Day Of Surgery: A Five Year Audit Report From The Aga Khan University Hospital Karachi, Abdul Monem, Amjad Nadeem, Fauzia Khan

Department of Anaesthesia

Objective: To assess the controllable factors in preventing undue cancellation of elective surgical cases and to suggest measures to address the issue.
Methods: The retrospective audit was conducted at the Aga Khan University Hospital, Karachi, and comprised all cancellations of elective surgery from 2011 to 2015. The cases reviewed had been cancelled primarily due to hypertension. A three-member committee regularly reviewed files regarding case cancellations and data was gathered.
Results: Of the 42,242 surgical cases scheduled during the period, 2903 (6.8%) were cancelled. In 11(0.37%) of these cases, hypertension was the primary reason. Of them, 10(91%) were men and 1(9%) …

Regional Variation In Chronic Kidney Disease And Associated Factors In Hypertensive Individuals In Rural South Asia: Findings From Control Of Blood Pressure And Risk Attenuation-Bangladesh, Pakistan And Sri Lanka, Liang Feng, Hithanadura Asita De Silva, Imtiaz Jehan, Anuradhani Kasturiratne, Gulshan Himani, Mohammad Abul Hasnat, Tazeen Jafar, Cobra-Bps Study Group

Community Health Sciences

Background: We aimed to determine the prevalence of chronic kidney disease (CKD) and its cross-country variation among hypertensive individuals in rural Bangladesh, Pakistan and Sri Lanka. We also explored the factors associated with CKD in these populations.
Method: We studied baseline data from the Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan and Sri Lanka (COBRA-BPS) trial, an ongoing cluster randomized controlled trial on 2643 hypertensive adults ≥40 years of age from 30 randomly selected rural clusters, 10 in each of the three countries. CKD was defined as an estimated glomerular filtration rate (eGFR) /min/1.73 m2 or a urine albumin:creatinine …

Prevalence And Correlates Of Cardiometabolic Multimorbidity Among Hypertensive Individuals: A Cross-Sectional Study In Rural South Asia—Bangladesh, Pakistan And Sri Lanka, Liang Feng, Imtiaz Jehan, H Asita De Silva, Aliya Naheed, Hamida Farazdaq, Samina Hirani Samina Hirani, Anuradhani Kasturiratne, Channa D. Ranasinha, Md Tauhidul Islam, Ali Tanweer Siddiquee, Tazeen Jafar

Community Health Sciences

Objective: To determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia.
Design: A cross-sectional study.
Setting: Rural communities in Bangladesh, Pakistan and Sri Lanka.
Participants: A total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial.
Main outcome measures: CMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM.
Results: …

Coronary Heart Disease, Hypertension And Use Of Biomass Fuel Among Women: Comparative Cross-Sectional Study, Zafar Fatmi, Georgia Ntani, David Coggon

Community Health Sciences

Objectives: To explore the associations of hypertension and coronary heart disease (CHD) with use of biomass fuel for cooking.
Design: Comparative cross-sectional study.
Setting: Rural villages in Sindh, Pakistan.
Participants: Women aged ≥40 years who had used biomass fuel for cooking for at least the last year (n=436), and a comparison group (n=414) who had cooked only with non-biomass fuel during the last year were recruited through door-to-door visits. None of those who were invited to take part declined.
Primary and secondary outcome measures: Hypertension was determined from blood pressure measurements and use of medication. CHD was assessed by three …

Frequency Of Peri-Operative Hypertension In A Tertiary Care Hospital In Karachi, Pakistan, Momena Sohail, Aysha Almas, Ayesha Majeed Memon, Bushra Usmani, Aamir Hameed, G. Afshan

Section of Internal Medicine

This study aims to determine the frequency of perioperative hypertension and its types (pre, intra and post-operative) hypertension in patients admitted for surgical procedures. This was a cross-sectional study conducted between the years 2012-2013 at the Aga Khan University Hospital, Karachi. Patients admitted for any surgical procedure during this time were included. Perioperative hypertension has been defined as systolic blood pressure of >140 mm Hg or a diastolic blood pressure of >90 mm Hg or whose blood pressure increased by 20% during surgery. A total of 428 surgical procedures were reviewed for the study. Overall perioperative hypertension was present in …

Serum Anti Mullerian Hormone And Renalase Levels In Predicting The Risk Of Preeclampsia, Zehra Jamil, Sana Shahid, Erum Baig, Rida Ahmad, Faryal Subhani, Syeda Sadia Fatima

Department of Biological & Biomedical Sciences

Objective: The aim of the study was to explore the association of serum AMH and Renalase with the risk of preeclampsia thereby assessing them as screening tools, reducing the risk of gravid consequences of preeclampsia.
Materials and Methods: This cross-sectional study recruited n = 95 pregnant women between 14 and 32 gestational weeks. They were categorized as a) women with gestational hypertension (n = 45); b) women with pre-eclampsia (n = 20) and c) normotensive pregnant women (n = 30) according to the ACOG criteria. Anthropometrics data and blood and urine samples were collected. AMH and Renalase levels were measured …

Determinants Of Uncontrolled Hypertension In Rural Communities In South Asia-Bangladesh, Pakistan, And Sri Lanka, Tazeen Jafar, Mihir Gandhi, Imtiaz Jehan, Aliya Naheed, H Asita De Silva, Hunaina Shahab, Dewan Alam, Nathasha Luke, Ching Wee Lim Wee Lim, Cobra-Bps Study Group

Community Health Sciences

Background: Uncontrolled blood pressure (BP) is a leading risk factor for death and disability in South Asia. We aimed to determine the cross-country variation, and the factors associated with uncontrolled BP among adults treated for hypertension in rural South Asia.
Methods: We enrolled 1718 individuals aged ≥40 years treated for hypertension in a cross-sectional study from rural communities in Bangladesh, Pakistan, and Sri Lanka. Multivariable logistic regression model was used to determine the factors associated with uncontrolledBP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg).
Results: Among hypertensive individuals, 58.0% (95% confidence interval 55.7, 60.4) had uncontrolled BP: 52.8% …

An Atypical Case Of Silent Aortic Dissection In A Peritoneal Dialysis Patient: A Case Report And Review Of Literature., Waqas Javed Siddique, Ali Arif, Mohammad Harisullah Khan, Maryam Khan, Muhammad Owais Hanif, Muhammad Junaid Mehboob, Muhammad Aslam, Ayesha Aslam, Hasan Arif, Sandeep Aggarwal

Medical College Documents

Objective: Unusual clinical course

Background: Aortic dissection presents with acute chest or back pain and is associated with high mortality. We present a case of aortic dissection with an atypical presentation in a peritoneal dialysis patient, and the challenges met with peritoneal dialysis.

Case Report: A 53-year-old African American male presented with progressively worsening exertional dyspnea and orthopnea for 3 days without any history of chest pain. His chest x-ray showed mild pulmonary edema. He was admitted with a diagnosis of heart failure. Bedside echocardiogram revealed severe aortic regurgitation and concern for possible aortic dissection. Computed tomography …

Risk Factors For Stroke And Tia's In Pakistan: A Community-Based Study, Abdul Malik, Farrukh Malik, Ismail Khatri, Sadaf Nasir

Pakistan Journal of Neurological Sciences (PJNS)

OBJECTIVES: To estimate the frequency of risk factors for stroke and transient ischemic attacks in Pakistan; a multi-city community-based study. METHOD: This cross-sectional community-based study was conducted in various health care facilities including government funded District Head Quarters hospitals, private hospitals and medical centers, and community-based clinics across 27 cities all over Pakistan over a period of three years between 2013 and 2015. Nearly 900 patients were screened during stroke (Falij) screening camps at these facilities and the data regarding past stroke and transient ischemic attack (TIA) symptoms were recorded along with relevant neurological examinations. A 25 item self-administered questionnaire …

Prevalence And Incidence Of Hypertension: Results From A Representative Cohort Of Over 16,000 Adults In Three Cities Of South Asia, Dorairaj Prabhakaran, Panniyammakal Jeemon, Shreeparna Ghosh, Roopa Shivashankar, Vamadevan S. Ajay, Dimple Kondal, Ruby Gupta, Mohammed K. Ali, Deepa Mohan, Viswanathan Mohan, Muhammad Masood Kadir, Nikhil Tandon, Kolli Srinath Reddy, K.M. Venkat Narayan

Community Health Sciences

Background: Despite high projected burden, hypertension incidence data are lacking in South Asian population. We measured hypertension prevalence and incidence in the Center for cArdio-metabolic Risk Reduction in South Asia (CARRS) adult cohort.
Methods: The CARRS Study recruited representative samples of Chennai, Delhi, and Karachi in 2010/11, and socio-demographic and risk factor data were obtained using a standard common protocol. Blood pressure (BP) was measured in the sitting position using electronic sphygmomanometer both at baseline and two year follow-up. Hypertension and control were defined by JNC 7 criteria.
Results: In total, 16,287 participants were recruited (response rate=94.3%) and two …

Multicomponent Intervention Versus Usual Care For Management Of Hypertension In Rural Bangladesh, Pakistan And Sri Lanka: Study Protocol For A Cluster Randomized Controlled Trial., Tazeen H. Jafar, Imtiaz Jehan, H. Asita De Silva, Aliya Naheed, Mihir Gandhi, Pryseley Assam, Eric A. Finkelstein, Helena Legido Quigley, Marcel Bilger, Aamir Hameed, John David Clemens, Shah Ebrahim, Elizabeth L. Turner, Anuradhani Kasturiratne

Community Health Sciences

BACKGROUND:

High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka.

METHODS/DESIGN:

This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home …