Background:Small amount of albumin excretion in urine, termed as microalbuminuria, has been postulated to be an indicator of endothelial dysfunction. This study was done to find the prevalence of microalbuminuria in patients with essential hypertension and to study the association of microalbuminuria with cardiovascular morbidity.Methods:This cross-sectional, observational study was conducted at the Department of Internal Medicine, Medical College and SSG Hospital, Baroda; by selecting 60 first time detected essential hypertensive patients, without any significant past or treatment history, attending Medicine outpatient department (OPD) or admitted in different wards at SSG hospital, for various reasons. A detailed history, clinical examination, basic blood investigation, urine albumin to creatinine ratio, electrocardiography (ECG) and 2D echo were done in all patients.Results:In this study, microalbuminuria was found in 24 (40%) cases with prevalence increasing with increasing age. A higher serum cholesterol, serum low density lipoprotein (LDL) and cholesterol/high density lipoprotein (HDL) ratio; left ventricular hypertrophy (LVH), ST-T changes and bundle branch block on ECG; LVH, hypokinesia and diastolic dysfunction on 2D echo; retinopathy on D fundus examination were all associated with higher microalbumin excretion in urine. Microalbuminuria was independent of age, sex, addiction to smoking, alcohol, BMI and severity/stage of hypertension. Thus, irrespective of existing known cardiovascular risk factors, microalbuminuria was associated with signs of cardiovascular morbidity.Conclusions:As a predictor of systemic vascular dysfunction, microalbuminuria can be used to stratify and prognosticate hypertensive patients at a higher risk of developing further vascular complications and they can be screened early for same.
This study examines the processes and mechanisms through which entrepreneurship leads to the empowerment and emancipation of women living in poverty. Drawing on the entrepreneuring as emancipation perspective, we identify specific activities through which emancipatory entrepreneuring manifests itself in the context of women’s entrepreneurship in India. We observe that the activities of a social entrepreneur—the SEWA trade union—complement the activities of individual entrepreneurs and lead to economic, personal, and cultural empowerment. Further, we find evidence of emancipation at the collective level, expressed in changes of sociocultural norms about women’s entrepreneurship. Our study extends the entrepreneuring as emancipation perspective and contributes to research on empowerment and emancipation, women’s entrepreneurship, and entrepreneurship in developing countries.
Abstract Learners in the higher education context who engage with computer‐based gamified learning systems often experience the novelty effect: a pattern of high activity during the gamified system's introduction followed by a drop in activity a few weeks later, once its novelty has worn off. We applied a two‐tiered motivational, online gamified learning system over 2 years to a total number of 333 students. In a mixed methods research design, we used 3‐year worth of longitudinal data (333 students for the treatment group and 175 in the control group) to assess students' engagement and performance in that period. Quantitative results established that students engaged and performed better in the gamified condition vis‐à‐vis the nongamified. Furthermore, students exhibited higher levels of engagement in the second year compared with the first year of the gamified condition. Our qualitative data suggest that students in the second year of the gamified delivery exhibited sustained engagement, overcoming the novelty effect. Thus, our main contribution is in suggesting ways of making the engagement meaningful and useful for the students, thus sustaining their engagement with computer‐based gamified learning systems and overcoming the novelty effect.
Our study retrospectively reviewed the presentation, neuro-radiological findings, and outcomes of eight adult patients presenting at our institution with subarachnoid haemorrhage (SAH), which was subsequently proven to be due to cortical venous thrombosis (CVT).We reviewed the case records and neuroimaging findings of eight patients diagnosed with SAH and CVT over a span of two years at our institution, a tertiary care centre in Western India. All details pertaining to their presentation, clinical findings, neuroimaging, management, and outcome following therapy with anticoagulants were collected until patient discharge.There were a total of eight patients, with the average age being 34 years (range 25-42). Only one patient was female. Six patients had a history of recent binge drinking. None of the patients had a past or family history of common risk factors for thrombosis. All patients presented acutely, with headache (n=6) and seizures (n=6) being the most common presenting features, occurring in three-quarters of the patients examined. Non-contrast computed tomography (NCCT) was the initial imaging study for all but one of the patients and showed cortical SAH (cSAH) without basilar haemorrhage. Magnetic resonance imaging/magnetic resonance venography (MRI/MRV) confirmed the underlying CVT. Unfractionated heparin was used in all cases. Seven patients improved and were discharged on oral anticoagulation. The eighth patient died.Localised cSAH with sparing of basal cisterns can be a presentation for CVT. In patients with cSAH, MRI/MRV can be useful to make a diagnosis of CVT. Anticoagulation for CVT, even in the presence of SAH was related to seven out of eight patients being discharged.
Heterogeneity in number of deaths in different countries during the ongoing nCOVID crisis challenged us to look for determinants of pandemic death toll across the world. Using the past two decades data of pandemic deaths in the world, this study considered if engagement in international trade, health care expenditure and population density have any impact on the pandemic death toll. Using linear regression model controlled for types of disease, we not only found trade significantly impacting death toll, but also surprisingly found positive correlation between share of healthcare expenditure in GDP and fatalities in pandemics. Our findings suggest that policy intervention is required for mitigating health impacts of trade and ‘tweaking’ the health expenditure towards pandemic prevention.
Background: The overall prevalence of heart failure (HF) is thought to be increasing, in part because current therapies for cardiac disorders such as myocardial infarction (MI), valvular heart disease and arrhythmias, are allowing patients to survive longer. Aims of the study were to know the presentation, causes, outcome of HF patients and to know the proportion of patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF).Methods: This was a cross-sectional observational study of heart failure patients for duration of one year, admitted in medicine department of medical college and SSG hospital, Vadodara, Gujarat, India.Results: Males constituted more than half of patients; however, HFpEF was more common in females in all age groups. Majority of patients had HFrEF. Breathlessness was the common presenting symptom. Common aetiologies found were ischaemic heart disease (IHD), hypertension (HTN), diabetes mellitus (DM) and valvular heart disease. 50-64 year patients constituted the major age group. IHD and DM were more common in this age group. Rheumatic heart disease (RHD) was seen commonly in 20-34 year of age group. In-hospital mortality rate though low has not much changed and contributes significantly considering the prevalence.Conclusions: Like developing countries, IHD contributes a major portion of patients with HF with risk factors like DM and HTN. Though, the contribution from RHD still cannot be ignored. There is little decrease in mortality but considering prevalence the burden is still high.
This paper examines the transformational role of entrepreneurship for the empowerment and sustained livelihood of women in poverty. We conducted a field study using interviews with 134 Indian women entrepreneurs in five categories of businesses. Although the women living under (extreme) poverty and oppressive socio-cultural norms engage in entrepreneurial activities out of desperation, the process of entrepreneuring has deeply transformational effects on their personal and professional lives. By working within and around the socio-cultural and institutional constraints they face, women entrepreneurs gradually redefine the norms and values of their families and communities to gain acceptance and recognition of their economic contributions. Further, the learning and personal growth they experience as a part of entrepreneuring are associated with elevation of their business goals from meeting basic subsistence needs to ensuring long-term sustained livelihood for their families. Our paper contributes to the entrepreneuring-as- emancipation perspective by extending its focus from an entrepreneurial project to a life-changing transformational process of empowerment.
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