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Biomedical subjects

N Gopinath

Publications and source records attributed to N Gopinath.

At least 19 recordsLinked to original sources
PubMed1997

Urban-rural differences in the prevalence of coronary heart disease and its risk factors in Delhi.

A community-based epidemiological survey of coronary heart disease and its risk factors was carried out over the period 1984-87 on a random sample of adults aged 25-64 years: 13,723 adults living in Delhi and 3375 in adjoining rural areas. ECG examination and analysis of fasting blood samples for lipids were performed on subjects with the disease and asymptomatic adults free of clinical manifestations. The overall prevalence of coronary heart disease among adults based on clinical and ECG criteria was estimated at 96.7 per 1000 and 27.1 per 1000 in the urban and rural populations, respectively. Prevalences of a family history of coronary heart disease, hypertension, obesity and diabetes mellitus were significantly higher in the urban than in the rural population, and smoking was commoner among rural men and women. Mean levels of total serum cholesterol and low density lipoprotein cholesterol were higher among urban subjects; the mean level of triglycerides was higher in rural subjects. The proportions with total cholesterol levels > 190 mg/dl were 44.1% and 23.0% in urban and rural men, respectively, and 50.1% and 23.9% among urban and rural women, respectively. High density lipoprotein cholesterol levels < 35 mg/dl were found in 2.2% of urban men and 8.0% of rural men compared with 1.6% and 3.5% among urban and rural women, respectively. An abnormal ECG pattern (Q wave or ST-T changes) in asymptomatic individuals is also considered to be a risk factor for coronary heart disease. In asymptomatic adults, 1.7% of urban men and 1.2% of urban women showed abnormal Q waves compared with 0.3% of rural men and 0.4% of rural women. A higher proportion of asymptomatic women showed ST-T changes in both populations. Rural men and women had higher total calorie and saturated fat intakes than urban subjects. Differences in dietary cholesterol intake were marginal. Sodium intake was greater in urban adults. Average daily consumption of alcohol by urban men was 12.7 ml ethanol compared with 2.4 ml in rural men.

Adult↗
PubMed1997

Nutrition and chronic diseases--Indian experience.

Socio-economic changes are taking place all over the world, especially in developing countries, and these influence all aspects of life an all age periods. Resultant disparities have brought about alarming and increasing manifestations of malnutrition and non-communicable disease. Illiteracy, poor health facilities have damaging effects on children. Raising the literacy of girls and adolescents will reduce the leading cause of malnutrition in children, since these future, better educated mothers will be responsible for the children's welfare: child care status with mother care. Protein calorie sufficiency is only present in approximately 60% of the rural population of India: the remainder has differing degrees of malnutrition. When they move into better socio-economic status people are at increased risk from coronary heart disease and diabetes mellitus, for which several theoretical explanations have been proposed. There is a difference in the patterns of these diseases in urban and rural populations, the exact basis for which is not yet clear. For example, in the 25-64 years age group, coronary heart disease prevalence in Delhi is 97/1,000 while in a rural area it is 27/1,000, while the respective figures for hypertension are 127/1,000 and 29/1,000. The patterns in both groups have changed within 3-5 years. The geriatric age group has its own, changing features, due to increasing longevity of life, and to break up of social customs and family structure.

Cardiovascular Diseases↗
PubMed1996

Prevalence and patterns of smoking in Delhi: cross sectional study.

OBJECTIVE: To determine the prevalence and predictors of smoking in urban India. DESIGN: Cross sectional. SETTING: Delhi, urban India, 1985-6. SUBJECTS: Random sample of 13,558 men and women aged 25-64 years. MAIN OUTCOME MEASURES: Smoking prevalence; subjects who were currently smoking and who had smoked > or = 100 cigarettes or beedis or chuttas in their lifetime were defined as smokers. RESULTS: 45% (95% confidence interval 43.8 to 46.2) of men and 7% (6.4 to 7.6) of women were smokers. Education was the strongest predictor of smoking, and men with no education were 1.8 (1.5 to 2.0) times more likely to be smokers than those with college education, and women with no education were 3.7 (2.9 to 4.8) times more likely. Among smokers, 52.6% of men and 4.9% of women smoked only cigarettes while the others also smoked beedi or chutta. Compared with cigarette smokers, people smoking beedi or chutta were more likely to be older and married; have lower education, manual occupations, incomes, and body mass index; and not drink alcohol or take part in leisure exercise. CONCLUSION: There are two subpopulations of smokers in urban India, and the prevention strategy required for each may be different. The educated, white collar cigarette smoker in India might respond to measures that make non-smoking fashionable, while the less educated, low income people who smoke beedi or chutta may need strategies aimed at socioeconomic improvement.

Adult↗
PubMed1995

Dietary profile of adults in an urban & a rural community.

A community based dietary survey was carried out in 906 adults (25-64 yr) from 489 families in Delhi urban population and 275 adults from 196 families in rural population of Gurgaon district (Haryana state). A combination of 24 h recall and weightment method was used to assess the individual dietary intake. Daily average intake of various nutrients was calculated. A higher intake of cereals, milk and milk products and sugar and jaggery and a lower intake of pulses, vegetables, fruits, flesh foods and oils and fats were observed in the rural population. The average total calorie intake was 1,749 kcal in the urban and 1,910 in the rural population. The average intake of carbohydrates and proteins was 257.3 g (59.0 en %) and 54.7 g (12.5 en %) in the urban population compared to 295.6 g (61.9 en %) and 63.0 g (13.2 en %) respectively in the rural group. The fat intake was the lowest in the urban low socio-economic group (45.5 g). The contribution of total fat to energy intake ranged from 24.6 en to 31.2 en per cent in different population groups. The rural group showed higher intake of calcium and iron than the urban population. Intake of retinol was higher in the high socio-economic group (urban) than other population groups. Urban/rural differences were observed in intake of retinol, thiamine, niacin, vitamin C and vitamin E. Daily dietary cholesterol intake was the highest in the urban high socio-economic group (119 mg). The fibre intake was higher in the urban than the rural population (8.0 g vs 7.4 g).

Adult↗
PubMed1995

An epidemiological study of coronary heart disease in different ethnic groups in Delhi urban population.

A community based epidemiologival survey of coronary heart disease (CHD) was carried out on a random urban sample of 13,560 adults of different ethnic groups in Delhi. CHD was diagnosed either on the basis of clinical history, supported by documentary evidence of treatment in hospital/home or on the ECG evidence in accordance with Minnesota Code. The prevalence rate of CHD on clinical basis per 1000 adults was the highest in Sikhs (47.3), lowest in Muslims (22.8) and identical in Hindus (31.8) and Christians (31.2). The prevalence rate/1000 of silent CHD on the basis of ECG was high in Muslims (89.5) and Sikhs (87.3), low in Christians (25.0) and intermediate in Hindus (60.0). The Sikhs showed the highest prevalence rate of myocardial infarct (MI) (15.5) and angina (AP) (31.8) compared to other communities. The prevalence rate of CHD on clinical basis was higher in males than females in all communities. The prevalence of silent CHD was higher in females in Hindus and Sikhs but in Muslims it was higher in men (94.8) than in women (85.2). The wide variations in prevalence rates of CHD in different ethnic groups cannot be explained satisfactorily on the basis of conventional risk factors and support the multifactorial etiological character of CHD.

Adult↗
PubMed1994

An epidemiological study of obesity in adults in the urban population of Delhi.

The prevalence of obesity and its associations were assessed during a community based epidemiological survey of coronary heart disease on a randomised sample of 13,414 adults in the age group 25-64 years living in urban Delhi. Body Mass Index (BMI) > 25 was considered to be the cut off point for defining obesity. By this criterion, the overall prevalence rate of obesity was 27.8%. Obesity was found to be more common in female subjects (Male--21.3%, Female--33.4%, p < 0.001). Obesity was more frequent in male subjects with lower physical activity compared to those doing heavier physical activity (29.3 vs 17.5%, p < 0.001). Physical activity did not influence the prevalence of obesity in females. Hypertension (24.8 vs 8.2%, p < 0.001) coronary heart disease (5.3 vs 2.4%, p < 0.001) and diabetes mellitus (3.2 vs 1.6%, p < 0.001) were more common in the obese than in the non-obese subjects. Hypercholesterolaemia (65.5 vs 53%, p < 0.001) and hypertriglyceridaemia (73.3 vs 61.1%, p < 0.001) were found to be associated with obesity.

Adult↗
PubMed1994

A 3-year follow-up of hypertension in Delhi.

A follow-up study of hypertension was carried out among adults in Delhi 3 years after an initial community-based epidemiological survey of the same population. The treatment and the severity status of 1115 out of 1749 individuals with hypertension detected in the initial survey were compared with those observed in the follow-up. The proportion of treated cases with controlled blood pressure rose from 10.8% to 60.8%. Among the cohort of 3611 subjects aged 25-64 years who were normotensive in the initial survey, 132 new cases of hypertension, were detected. The annual incidence of hypertension was the same in men and women (12.2 per 1000). Diabetes and regular alcohol consumption were significant risk factors for hypertension, being present in 13 and 7 cases, respectively. Electrocardiograms (ECGs) were recorded for 871 of the 1115 cases of hypertension. Abnormal ECGs were exhibited by 307 cases (35.2%), of which 24 (2.7%) had had myocardial infarction, 133 (15.3%) had ischaemic ST-T changes, 54 (6.2%) had left ventricular hypertrophy, and 96 (11.0%) had conduction defects and arrhythmias.

Adult↗
PubMed1994

Epidemiological study of hypertension in young (15-24 yr) Delhi urban population.

A community based epidemiological study of hypertension was carried out on a random urban sample of young persons (15-24 yr) of Delhi. Hypertension was defined as systolic blood pressure greater than 140 mmHg and/or a diastolic blood pressure greater than 85 mm Hg or a history of current antihypertensive therapy. Of the 6543 subjects examined, 202 were found to be hypertensive. The overall prevalence rate was 30.9/1000 (male 41.2/1000, female 21.7/1000). Secondary hypertension was present in 4 of the 202 patients. Only 16 patients were aware of the presence of hypertension; of these 6 were on medication. Family history of hypertension was present in 87 subjects (43.1%). Of the 202 hypertensives, 67 were obese and 16 were smokers. The degree of physical activity was identical in the hypertensive and non-hypertensive subjects. Blood samples of 129 of the 202 patients were analysed for lipid levels. High values of total cholesterol were observed in nine.

Adolescent↗
PubMed1993

A 3-year follow-up study of coronary heart disease in Delhi.

A follow-up study of coronary heart disease (CHD) was carried out among adults in Delhi 3 years after an initial community-based epidemiological survey of the same population. A total of 575 of the 814 cases of CHD detected clinically and by electrocardiogram (ECG) in the initial survey took part. On re-examination of the original cohort of 4151 adults who were free of CHD both clinically and by ECG in the initial survey, 245 new cases of CHD were detected - 73 on a clinical basis (21 with myocardial infarction and 52 with angina pectoris) and 172 by ECG (13 with myocardial infarction and 159 with probable CHD based on ST and T changes). The overall incidence of CHD was 19.7 per 1000 (males, 17.3 per 1000; females, 21.0 per 1000). The incidence on a clinical basis was 5.9 per 1000 (males, 6.5 per 1000; females, 5.5 per 1000) compared with 13.8 per 1000 by ECG (males, 10.8 per 1000; females, 15.5 per 1000). Although the incidence of myocardial infarction was higher in men (3.6 per 1000) than women (2.2 per 1000), the incidence of angina pectoris was 36.5% higher in women (18.7 per 1000) than in men (13.7 per 1000). Hypercholesterolaemia and systemic hypertension were the commonest risk factors in the 245 new cases.

Adult↗
PubMed1992

Epidemiological study of coronary heart disease in Gujaratis in Delhi (India).

A community based survey of coronary heart disease (CHD) was carried out in Gujarati families settled in Delhi. The number of adults surveyed in the age group 25-64 yr was 1317. CHD was diagnosed either on the basis of clinical history supported by documentary evidence of treatment in the hospital or at home or on ECG evidence in accordance with the Minnesota Code. The prevalence rate of CHD on clinical history was 25.1 (28.2 in males and 22.4 in females) per 1000 adults (25-64 yr). The prevalence rates were slightly lower in Gujaratis than the general Delhi urban population. The prevalence rate based on both clinical history and ECG criteria was estimated at 66.8 as compared to 96.8/1000 in general urban Delhi population. The risk factors for CHD such as socio-economic status, family history, obesity, smoking, physical activity and hypertension were studied. The mean and 5th, 50th and 95th percentile values of blood lipids were also estimated in CHD patients and compared with the control group. Hypertension ranked the leading risk factor. Prevalence rate of CHD was higher in the upper socioeconomic group. The positive correlation of higher levels of serum lipids e.g., total cholesterol, low density lipoprotein cholesterol (LDL-C) and triglyceride with CHD was confirmed.

Adult↗
PubMed1990

Histopathology of cocaine hepatotoxicity. Report of four patients.

Although cocaine is believed to be hepatotoxic for humans, the hepatic histopathology has been reported in only 1 patient. That patient had zone-1 necrosis. We have encountered 4 patients with liver injury secondary to cocaine use, 1 of whom died. The biopsies from two patients showed well-demarcated zone-3 necrosis identical to that seen with acetaminophen toxicity. The patient who died had necrosis of almost all hepatocytes as found at biopsy and autopsy. Biopsy was performed on another patient after resolution of the illness, and showed hyperplastic endoplastic reticulum but no necrosis. All patients had mild large- and small-droplet steatosis in surviving hepatocytes. Inflammation was mild. Drug screenings performed on all patients showed the presence of a cocaine metabolite and the absence of acetaminophen, alcohol, and other potential toxins. Patients typically had early marked increase and rapid decrease of serum aminotransferases, mild-to-moderate increase in prothrombin time, myoglobinuria, and moderate azotemia. The predominant pattern of zone-3 necrosis is similar to that reported of mice given cocaine.

Adult↗
PubMed1990

Epidemiological study of coronary heart disease in urban population of Delhi.

A community based survey of coronary heart disease (CHD) was carried out on a random urban sample of 13,723 adults in the age group 25-64 yr in Delhi, India. CHD was diagnosed either on the basis of clinical history supported by documentary evidence of treatment in a hospital or at home; or on ECG evidence in accordance with the Minnesota Code. The overall prevalence of CHD based on clinical history, was 31.9 (39.5 in males and 25.3 in females) per 1000 adults in this age group. The number of patients with CHD increased with advancing age in both sexes. The total prevalence rate based on both clinical history and ECG criteria (asymptomatic patients with ECG changes of definite myocardial infarction and ST-T changes suggestive of CHD) was estimated as 96.7/1000 adults in this age group. Analysis of information on socio-economic status, family history of CHD, obesity, hypertension and smoking obtained from this sample of 13,723 adults suggested that hypertension had the strongest association with CHD. Obesity, diabetes and family history were also found to be associated with CHD. It should, however, be noted that risk factor assessments in CHD can be done satisfactorily only through incidence studies.

Adult↗
PubMed1990

Prevalence, awareness & treatment status of hypertension in urban population of Delhi.

A community based survey for the prevalence of hypertension was carried out on a random urban sample of 13,723 adults in the age group 25-64 yr from the Union Territory of Delhi (India). Hypertension was defined as systolic pressure greater than 160 mm Hg and/or a diastolic pressure greater than 90 mm Hg or a history of current antihypertensive medication. The overall prevalence rate/1000 adults was 127.5 (116.6 in males and 136.8 in females). Mild hypertension (diastolic pressure between 91-104 mm Hg) predominated in the whole group, the proportion decreasing with increasing age in both sexes. Fifty per cent of the hypertensives were aware of their problem, the awareness being slightly higher in females (51.8% versus 46.5%). Approximately 30 per cent of the hypertensives were on medication for high blood pressure. The status control of blood pressure was low in the population, being only 9 per cent, with little difference between the two sexes. The study emphasises the enormity of the problem of hypertension in an urban population in India and poor control of blood pressure achieved in the community.

Adult↗
PubMed1990

Small intestinal villous adenoma and celiac disease.

We describe the first patient with presumed celiac disease to present with a jejunal villous adenoma. Small bowel adenocarcinoma complicating celiac disease probably arises from adenoma, although this has not been previously addressed. The literature concerning factors in celiac disease predisposing to small intestinal epithelial neoplasia is reviewed.

Adenoma↗
PubMed1986

Fine-needle aspiration biopsy of adrenal tuberculosis.

Adrenal tuberculosis remains an important cause of Addison's disease. Acute tuberculosis adrenalitis may produce mass-like enlargement of the glands which requires differentiation from primary or secondary neoplastic disease. Using percutaneous fine-needle aspiration biopsy, the authors made the diagnosis of tuberculosis adrenalitis in two patients who presented with Addison's disease; and enlarged adrenal glands seen using computed tomography.

Adrenal Gland Diseases↗
PubMed1984

Thrombotic obstruction of Bjork-Shiley valves--diagnostic and surgical considerations.

We have evaluated 12 patients with thrombotic obstruction of the Bjork-Shiley valve since 1975, 11 in the mitral and 1 in the aortic position. During this period 442 patients with 303 mitral (181 plano-convex and 122 convexo-concave) and 205 aortic (112 plano-convex and 93 convexo-concave) Bjork-Shiley valves were available for follow-up. The incidence of thrombosis for the plano-convex model was 1.06% per patient year for the mitral position and 0.19% per patient year for the aortic position. The new convexo-concave model has brought down the incidence to 0.78% per patient year for the mitral (P less than 0.01) and 0% per patient year for the aortic valve. The onset of symptoms was acute (less than 15 days) in 41.7% and subacute (greater than 15 days) in 58.3% patients. All patients presented with pulmonary edema. Evidence of inadequate anticoagulation was present in only 3 (25%) patients. Reduction of prosthetic sounds and appearance of a new murmur was highly suggestive of valve thrombosis. Echocardiography and cinefluoroscopy was very useful for the instant recognition of this condition and had obviated the need for cardiac catheterisation in the last 6 patients. Emergency surgery was obligatory in all. Thrombectomy alone was successful in 9 patients. Three patients required replacement of the prosthesis. There was one operative death (mortality 8.3%). The long-term follow-up of these patients (3-82 months, mean 34 months) is excellent. We conclude that thrombotic obstruction of the Bjork-Shiley valve is often not related to inadequate anticoagulation, and more than half of the patients do not present with abrupt onset of symptoms. The convexo-concave model has significantly reduced this problem. Emergency surgery with thrombectomy is the procedure of choice for clotted prostheses.

Adult↗
PubMed1984

Valve replacement in children under twenty years of age. Experience with the Björk-Shiley prosthesis.

Prosthetic valve replacement in young patients has been reported to be associated with a high mortality and morbidity because of valve-related problems. Of 549 patients undergoing valve replacement with the Björk-Shiley valve prosthesis, 136 were under the age of 20 years. Sixty-four patients were under 16 years of age, the youngest being 6 years old. Of the 136 patients, 61 underwent mitral valve replacement, 50 received an aortic valve, and 25 received both aortic and mitral valves. Overall operative mortality was 10.3%. Late mortality over a follow-up period of 6 months to 8 years was 4.4%. Actuarial survival curves up to 8 years of follow-up are presented. Results obtained in this group are compared with those obtained in 413 patients over 20 years of age operated during the same period. Valve thrombosis was not seen in any patient under 20 years of age, but it occurred in 4.13% of the patients over 20 years of age. The incidence of thromboembolism and anticoagulant-related hemorrhage was very low. There has been no instance of structural failure of the valve. Long-term results are excellent, with 90% of the survivors returning to New York Heart Association Functional Class I. The Björk-Shiley valve gives excellent and durable long-term palliation in young patients requiring valve replacement.

Actuarial Analysis↗