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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 5 | Issue 4
Page Nos. 155-210

Online since Thursday, December 31, 2020

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EDITORIAL  

Coronavirus disease 2019 and noncommunicable diseases: Lessons learned so far and implications for the future p. 155
Kavumpurathu Raman Thankappan
DOI:10.4103/jncd.jncd_92_20  
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ORIGINAL ARTICLES Top

Awareness of patients regarding self-management of heart failure attending a tertiary care hospital of North India p. 158
Bandna Kumari, Sukhpal Kaur, Monika Dutta, Ajay Bahl, Parag Barwad
DOI:10.4103/jncd.jncd_41_19  
Background: Heart failure is a rampant health problem affecting millions of people worldwide. Patients' knowledge about this complex disease contributes toward its self-management at home thereby, reduction in frequent hospitalizations and increased health-care cost. Aim: This study aims to assess the awareness of patients regarding self-management of heart failure. Methods and Results: A cross-sectional study was conducted on diagnosed patients having heart failure for at least 6 months with left ventricular ejection fraction <40% from functional class New York Heart Association II–IV ambulatory. One hundred and one participants were interviewed individually during routine visit. A prevalidated questionnaire was used to collect demographic characteristics, status of illness and knowledge of patients. Data were analyzed using descriptive and inferential statistics. 66.3% of the patients had insufficient knowledge about heart failure. Acceptable level of knowledge was found in 11.9% of the participants. Weak linear correlation (r = -0.232, P = 0.019) was found between education and mean knowledge score. Significant association of education and habitat with higher knowledge was seen in binomial logistic regression model. Conclusion: Lack of awareness regarding self-management of disease was found in majority of the patients. Structured teaching programs with special emphasis on nature of illness, lifestyle modifications, identifying worsening symptoms and their management at home were needed. Heart failure, knowledge, self-management
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Relationship between diabetes mellitus and indoor air pollution: An exploratory analysis p. 165
Sandeep Mishra, Leslie A McClure, Vijay Golla, Vasudeva Guddattu, Claudiu Lungu, Nalini Sathiakumar
DOI:10.4103/jncd.jncd_38_20  
Context: Diabetes is one of the leading causes of morbidity and mortality worldwide. India has the second highest number of individuals with diabetes in the world and these numbers are predicted to reach 120 million by 2045. Environmental exposure to particulate matter and nitrogen dioxide has been identified as a risk factor for diabetes However, to date, no published studies have examined the association of indoor air pollution (IAP) and diabetes in developing countries such as India, where traditional biomass fuels are still used for cooking and heating. Aims: To evaluate the association between IAP and diabetes mellitus. Settings and Design: The data collected through India&#39;s third National Family Health Survey (NFHS-3) in 2005–2006 were queried and analyzed. Materials and Methods: This study examined the association between IAP and diabetes among women aged 45 years and above using data from the NFHS-3. Statistical Analysis: Multivariable regression analysis was used to determine the relationship between diabetes and type of fuel, calculate adjusted odds ratios (OR) and the 95% confidence interval (CI) after adjusting for confounders. Results: Less than 1/3 of the 9,502 (28%) participants were overweight or obese and 304 women reported having diabetes. A statistically significant association between solid fuel use and diabetes in women &#62;45 years of age was observed (OR: 1.59; 95% CI: 1.08–2.34). Conclusions: This study is the first attempt to determine the relationship between diabetes and IAP; more robust population-based cohort studies are needed to further explore this association.
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Situational analysis of practice patterns and challenges in cardiovascular disease management: A qualitative study p. 171
Farah Naaz Fathima, Twinkle Agrawal, Padmini Nidhin, Denis Xavier
DOI:10.4103/jncd.jncd_55_20  
Background: Optimal management of cardiovascular diseases (CVDs) in developing countries is hindered by challenges among patients, caregivers, and health-care providers, understanding which is critical for CVD control. Objective: To explore the perspectives of patients with CVD, their caregivers, and health-care providers on the burden of the disease and challenges in management and to evolve strategies for improvement of care. Methods: A qualitative study using focus group discussions (FGDs) with patients and caregivers and in-depth interviews (IDIs) with care providers was conducted. Thematic analysis of data from FGDs and IDIs was done by inductive examination of textual information. Key subthemes and themes that emerged were recorded. Results: A total of 12 FGDs and 13 IDIs were conducted. Participants perceived CVDs as a big problem in both urban and rural areas. Lack of resources and time, lengthy and tedious procedures, high patient load, lack of awareness about standard treatment guidelines among private practitioners, and inadequate involvement of family members emerged as the key challenges in the control of CVDs. Training of private practitioners, nurse educators, and doctors in the public health system; strengthening of the existing national program; and greater involvement of family members in care of patients were the key strategic suggestions for improvement of care in CVD. Conclusion: Control of CVDs is laced with many challenges which involve multiple stakeholders. Addressing this issue demands a multipronged approach with interventions directed at empowering the patient and the caregivers and enhancing their involvement in care along with strengthening the health system.
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Assessment of 5-year risk of cardiovascular events among adults residing in an urban underprivileged area of Bangalore city: A community-based cross-sectional study p. 178
Nancy Angeline Gnanaselvam, Avita Rose Johnson, Somya Andrea Gomes, JV Jeskezia, Niresh Chandran, Suchitra Bajaj
DOI:10.4103/jncd.jncd_60_20  
Background: Cardiovascular disease (CVD) is the major cause of premature morbidity and mortality in India and is undergoing an epidemiological transition, now affecting the urban poor. It is important to assess patients for CVD risk and mitigate risk factors as a primary mode of prevention of CVD accordingly. Objective: The objective of the study was to assess the 5-year risk of cardiovascular events and the prevalence of CVD risk factors in an underprivileged area of Bangalore City. Methods: Community-based house-to-house survey of all adults aged 30 years and above, using an interview schedule on Epicollect mobile application, capturing sociodemographic details and CVD risk factors based on the INTERHEART risk assessment which included dietary risk factors, smoking and alcohol, physical activity, and central obesity. Blood pressure, random blood sugar, height, weight, and waist circumference measurement were done. The National Health and Nutrition Examination Survey CVD risk assessment charts were used to calculate the 5-year risk of a cardiovascular event. Results: Of 1184 study participants, 23% had moderate risk (10%–20%) and 30% had high risk (>20%) of a cardiovascular event in the next 5 years. Factors such as being not currently married, belonging to a religious minority, lower education, not being gainfully employed, belonging to a joint family, and salty food consumption were significantly associated with higher CVD risk. Conclusion: Urban underprivileged areas with undermined social determinants of health have significantly high burden of CVD risk and hence require a holistic approach to CVD risk assessment and noncommunicable diseases care starting with easy to use CVD risk assessment charts by community level health workers. Cardiovascular diseases risk assessment, diabetes, hypertension, noncommunicable diseases, urban health
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Glycemic efficacy and safety of hydroxychloroquine in type 2 diabetes mellitus: A systematic review and meta.analysis of relevance amid the COVID-19 pandemic p. 184
Rimesh Pal, Mainak Banerjee, Ashok Kumar, Sanjay Kumar Bhadada
DOI:10.4103/jncd.jncd_69_20  
Aims: Hydroxychloroquine (HCQ) is approved for use as an oral anti-diabetic drug (OAD) in patients with uncontrolled type 2 diabetes mellitus (T2DM); however, robust data are lacking. The present meta-analysis was conducted to provide precise effect estimates regarding the efficacy and safety of HCQ in patients with T2DM. Methods: PubMed/Cochrane Library and grey literature were systematically searched till August 25, 2020, to identify randomized controlled trials (RCTs) with duration =12 weeks, evaluating the efficacy and safety of HCQ (400 mg/day) in patients with T2DM and glycated hemoglobin (HbA1c) =7.0%–7.5% already on a combination of metformin/sulfonylurea compared to either placebo or another OAD. Results: We identified eight eligible RCTs, pooling data retrieved from 1763 patients with T2DM. HCQ resulted in significant decrease in HbA1c by 0.88% (95% confidence interval [CI]: -1.01 to - 0.75) compared to placebo and by 0.32% (95% CI: -0.37 to -0.26) compared to an OAD. Besides, there were significant reductions in fasting blood glucose, postprandial blood glucose, body weight, triglycerides, and low-density lipoprotein. A small but significant increase in high-density lipoprotein was also noted. An increase in the risk of any episode of symptomatic hypoglycemia (whether documented or not) was observed (risk ratio = 1.34 [95% CI: 1.10–1.63]). No other safety issues were identified. Conclusions: The meta-analysis suggests that HCQ, used as an add-on drug in patients with T2DM exerts significant beneficial effects on glycemic control, body weight, and lipid profile, however, increasing the risk for symptomatic hypoglycemia. HCQ might be useful amid the ongoing pandemic, as the drug has also been found to be beneficial in COVID-19.
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REVIEW ARTICLES Top

Availability of oral liquid formulations: Dilemmas in managing children with nephrotic syndrome p. 194
Chakrant Mothsara, Karalanglin Tiewsoh, Avaneesh Kumar Pandey, Samir Malhotra, Nusrat Shafiq
DOI:10.4103/jncd.jncd_7_20  
Conditions such as nephrotic syndrome (NS), which require administration of drugs for a protracted period, present a difficult situation for pediatricians to treat due to lack of appropriate formulations. In the present study, we explored the issue of availability of pediatric oral formulations and suggested solutions with NS as an example. We searched PubMed, Embase and Ovid, Google, Google Scholar, Current Index of Medical Specialties-Monthly Index of Medical Specialties, and standard textbooks for data acquisition. We found that many drugs used in NS are either not available in suitable pediatric formulation or are not specifically approved for use in pediatric population. Most of these drugs have high pharmacokinetic variability, which further necessitates the availability of proper formulation. Standardized compounding vehicles are also not available in our country. Manipulation of existing adult dosage forms for administering to pediatric patients is often arbitrary and may be associated with either underdosing or overdosing. There is an urgent need for development and standardization of compounding vehicles so that required dose delivery can be ensured in children with NS.
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Dietary recommendation in diabetes care: Carbohydrate counting and caloric content of Nigerian foods p. 201
Taoreed Adegoke Azeez, Patience Chimah, Abdul Fattah Hassan, Adedeji Moradeyo, Ubong Umoren, Emmanuel Eguzozie
DOI:10.4103/jncd.jncd_64_20  
The prevalence of diabetes mellitus is rising globally and even more in low- and middle-income countries such as Nigeria. Optimal management of the disease is important to improve survival and prevent or delay its complications. Lifestyle management is a standard universal approach in optimizing the care given to diabetic patients. Dietary management is the central link in lifestyle modifications of individuals living with diabetes. Medical nutrition therapy (MNT) is a systematic therapeutic approach of assessing the nutritional needs of an individual, determining nutritional goals, counseling the clients on how to achieve the goals, prescribing and monitoring meal plans to achieve the goals. It is evidence-based, effective, and highly recommended. All carers of the diabetes patient, including the health workers and the family members of the patients need to have basic understanding of MNT but the efforts should be coordinated by licensed dietitians. There are evidences that adherence to prescribed calories is effective in the control of cardiovascular risk factors such as blood glucose, weight, lipid profile, and blood pressure. However, prescription of calories should be based on thoughtful consideration of the nutritional needs, weight goal, personal preferences and tastes and cultural practices of individuals living with diabetes mellitus. Food pyramids give a graphical illustration on the recommended classes and servings of food. Six to eleven servings per day of carbohydrates, 3–5 servings per day of vegetables, 2–4 servings per day of fruit, 2–3 servings per day of dairy products, and 2–3 servings per day of fish are the recommended proportions of the different classes of foods for an adult on an average of 2000 calories. Carbohydrate counting, taken with appropriate insulin dosing and physical activity, has been demonstrated to be effective in optimizing the glycemic control of patients on multiple daily insulin injections. There are challenges in doing this in Nigeria due to lack of food labels. The caloric contents of common Nigerian foods are highlighted so as to help in achieving dietary goals.
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RESEARCH PROTOCOL Top

Development and validation of composite risk score to assess risks of major noncommunicable diseases in Northern Indian populations: A research protocol p. 207
Ria Nangia, JS Thakur, Anil Kumar Bhalla, Ajay Duseja
DOI:10.4103/jncd.jncd_23_19  
Background: Noncommunicable diseases (NCDs) which mainly consist of cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases account for 38 million deaths out of the 56 million deaths globally and 54% of healthy life years lost in 2012. Risk scores predict the risk of the disease efficiently, and an important strategy to prevent or delay the occurrence of chronic diseases is the early identification of those with undiagnosed NCDs. Methods: Two different population-based studies will be used for the development of the score and its validation. Secondary data from WHO STEPS Survey Haryana of 5250 individuals will be used to develop the predictive score and will be validated using STEPS Punjab data. Risk predictors will be used as the independent factors in the multivariate logistic regression and the dependent variable will be the disease. The regression coefficient will be used to assign each variable category a score. Risk score will be derived from receiver operating characteristic curve and the optimal cut-off will be determined using Youden's Index. Measures of overall predictive accuracy, discrimination and calibration will be used to assess predictive performance. Discussion: The present study is an attempt to develop a composite risk score for major NCDs so that effective preventive and control measures can be initiated once the risk is known. The developed tool will help in risk assessment and the successful implementation of NCD programs.
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