S. Sriram

Sleep-disordered breathing (SDB) was first described in the medical literature in 1936.Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is the most common type of SDB, affecting 4% of men and 2% of women aged 30–65 years with a total population prevalence of 1–2%.There are many associations between cardiovascular diseases and sleep disordered breathing (SDB).The objective of the study is to determine the prevalence, risk factors, and severity for sleep disordered breathing in patients with cardiac disorders. A Prospective, Observational, Comparative Study on the Relationship between Sleep Disordered Breathing [SDB] and Cardiac Disorders was conducted in the Cardiology Department of a hospital in Coimbatore. The data was collected during ward rounds and severity of SDB measured with the help of two questionnaires: Epworth Sleepiness Scale and Stop-Bang questionnaire. A total of 93 cases with various cardiac disorders were analyzed. The results indicated that males (69.8%) were predominantly more than females (30.1%) in the study. The study shows that (31.1%) patients were observed with Ischemic Heart Disease condition, (31.1%) patients with Ischemic Heart Disease/Systemic Hypertension, (10.7%) patients had Systemic Hypertension as major diagnosis. Assessment using Epworth scale shows that (30.1%) patients had moderate risk, (27.9%) patients with severe risk and (24.7%) were having mild risk. Assessment using Stop- Bang shows that (49.4%) had intermediate risk, followed by (32.2%) patients with high risk and (18.2%) with low risk. The results demonstrated an increased risk for sleep disordered breathing in cardiac disorders.

The use of bronchodilators has been increasing for the past few decades. Study was planned to evaluate the rational use of bronchodilator drugs by analyzing the appropriateness of the prescription. A prospective observational study was conducted in all the patients who were prescribed with bronchodilators in the pediatric ward. The demographic data and the bronchodilator prescribed were recorded in the data entry format. In the study population of 133 wheezing associated with lower respiratory tract infection was the most predominant disorder found in 35.3% children.  Of the 133 pediatric patients, the major prescription was for SABA (Short Acting Bronchodilators) (99.2%). Of which the major prescription was for salbutamol (63.2%). Most of the children with asthma were prescribed with combination therapy of salbutamol and ipratropium (81.3%). In WALRI (Wheezing Associated Lower Respiratory Tract Infection), patient were prescribed with salbutamol (40.4%) and. In acute bronchiolitis, the major prescription was found to be salbutamol and ipratropium combination (70.3%). In 52.6% of the prescriptions bronchodilator were given by nebulization and oral route, 31.6% were given by nebulization. In 95.5% of patient antibiotics were prescribed along with bronchodilators, followed by mucolytic 55.6% .Other concurrent prescriptions were with steroids (38.3%). It was found that 77.4% of pediatric patients not received any oxygen supplementation. The study found over use of antibiotics, sedatives and mucolytics and under use of steroids. Bronchodilator use was optimal but evaluation of therapy was not done commonly. The study highlighted the need for a local protocol and continuing staff and parent education.

To assess the prevalence and types of lipid abnormalities, analyze the rationalein the drug therapy and drug interactions in the drug therapy. Each patient’s medication profile was reviewed and patients who met the inclusion criteria were briefed on the study. The data from medical charts of all the cases with lipid abnormality were recorded during ward rounds. The study population included patients with primary dyslipidemia (38.8%) and secondary dyslipidemia (61.2%). The major concomitant disease was systemic hypertension followed by Diabetes Mellitus. Majority of the patients were in non CHD category. 88.7% of non CHD patients had 2+ risk factors and 11.3% had 1 risk factor. The non CHD group were subjected for estimation of 10 year risk percentage for having CHD using Framingham’s scale in which 92% of non CHD patients had ≤ 20% ten year risks for having CHD. The drug interactions with lipid lowering agents were 33.3% and without lipid lowering agents were 66.7%. The major drug interactions with lipid lowering agents were high. Conclusion: Results revealed that Diabetes, Thyroid Disorders, Nephrotic Disorders are responsible for elevation of lipid profiles. Some dyslipidemias appear to be refractory to drug treatment in the presence of an ongoing unrecognized secondary cause.