Practical Guide to Managing Hypertension - ECAB
Practical Guide to Managing Hypertension - ECAB

Author: S S Iyengar

Publisher: Elsevier Health Sciences

Published: 2012-06-08

Total Pages: 130

ISBN-13: 813123178X

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This book is an effort by the author panel to address hypertension issues in a more comprehensive manner and present to practitioners as a ready reference. It covers different practical aspects related to hypertension like the burden of hypertension in India, its complications and comorbidities, its awareness and early detection, appropriate treatment, and achieving the therapeutic targets. Hypertension can be easily detectable, eminently treatable, and there are safe and effective drugs. But in India, there has been a huge lack of awareness of the condition especially urban-rural bias, and thus, it results in inadequate treatment. The prevalence of hypertension in India, in the urban areas, varies from 11% to 31% amongst men and 13% to 34% amongst women. In rural areas, the same amounts to about 1–4% and 3–5%. This publication covers the major global and Indian hypertension management guidelines and tries to sincerely put forth this compilation which will address the most important and frequently asked questions in approach to diagnosis and management of hypertension in day-to-day practice and will effectively bridge the gap between guidelines and practice. Application of global hypertension management guidelines like JNC VII in Indian Clinical Scenario Highlighting the compliance issues in hypertension management Focusing on the screening and the right treatment goals of hypertension On the management aspect, the publication provides a holistic management approach covering drugs, diet, and lifestyle changes

Pulmonary Hypertension - ECAB
Pulmonary Hypertension - ECAB

Author: Sheila Glennis Haworth

Publisher: Elsevier Health Sciences

Published: 2008-12-26

Total Pages: 182

ISBN-13: 8131231763

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Pulmonary hypertension is defined as a mean pulmonary artery pressure (mPAP) ≥25 mmHg, with Pulmonary Capillary Wedge Pressure ≤ 15 mmHg, measured by cardiac catheterization. The etiology of PH has a varied spectrum extending right from Drugs, toxins and portal hypertension to HIV, Collagen Vascular Diseases and Persistent Pulmonary Hypertension of Newborn, etc. The estimation of disease prevalence has been nearly impossible owing to the geographic distribution and economic diversity, along with significant regional variations in human development and healthcare infrastructure. A large number of patients with PH never reach the health centers capable of diagnosing the disease condition correctly. Advance pulmonary vascular disease as a result of uncorrected CHD is a major health challenge in the developing world. PH exists as a major component of many forms of cardiac and pulmonary disease. While breathlessness is the most common feature of PH, patients often also present with chest pain, syncope, fatigue, weakness and abdominal distension. The precordial signs include a right ventricular lift, accentuated pulmonary component of S2, a pansystolic murmur of Tricuspid regurgitation, a diastolic murmur of pulmonary regurgitation and a right ventricular S3. The standard diagnostic workup in developed countries includes a series of investigations to rule out the secondary causes. Additional tests are required to estimate the disease severity and plan the appropriate treatment. These include the cardiac catheterization, selective pulmonary angiography by direct injection of pulmonary arteries, high resolution CT scan, cardiac magnetic resonance, ABGs, nocturnal O2 saturation, etc. While most of the basic management is feasible in the Indian conditions, most of the newly introduced drugs are either not available or are available at costs that far exceed the paying capacity of an average citizen of a developing economy. An underdeveloped health insurance system adds further to the financial burden of the treatment. Measures like formulation of guidelines for diagnosis and treatment of PAH, educating clinicians and scientists and making medications affordable to poor patients might ensue a breakthrough in the overall management of pulmonary hypertension.

Diabetic Kidney Disease - ECAB
Diabetic Kidney Disease - ECAB

Author: K V Dakshinamurty

Publisher: Elsevier Health Sciences

Published: 2013-07-22

Total Pages: 223

ISBN-13: 8131232026

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The prevalence of Diabetes Mellitus is increasing rapidly all over the world and more so in the developing countries. The global burden of diabetes is expected to double between 2000 and 2030, with the greatest increases in prevalence occurring in the Middle East, sub-Saharan Africa and India. Moreover, the development of type 2 diabetes during the childbearing years is also likely to increase, primarily in the developing countries. It has already been established that Diabetes is the most common primary cause leading to end stage renal disease (ESRD) and Diabetic Nephropathy is the leading cause of chronic kidney disease (CKD) in India. The cornerstones of management of Diabetic Kidney Diseases include early diagnosis of diabetic nephropathy, prevention of its progression and treatment of the co-morbid conditions. Substantial under-diagnosis of both diabetes and chronic kidney disease leads to lost opportunities for prevention. An inadequate or inappropriate care of patients with diabetic kidney disease contributes to disease progression eventually up to a stage that requires renal replacement therapy, which is not a feasible option for many on a long-term basis, especially in a developing country like ours. This book covers various aspects of diabetic kidney disease in detail and attempts to familiarize the reader with the existing aspects of the conditions as well as touch upon the new advances in the field. The first chapter outlines the extent to which the condition affects the population globally as well as in our country. The second chapter explores the underlying mechanism by which the disease starts and progresses and the pathological markers of the same. The third chapter delineates the clinical and diagnostic markers of the condition. The fourth and fifth chapters speak of the non-diabetic glomerular and non-glomerular diseases in diabetics. The sixth chapter addresses the most important and desirable goal of preventing the progression and ideally the onset of the disease. The seventh chapter puts together the various treatment modalities available and the subsequent chapter explores the management options for cases requiring renal replacement. In addition to the emphasis to Indian literature at the end of each chapter, the ninth chapter is specially included to highlight the salient aspects of this condition from the Indian perspective. This book will be beneficial not only for the nephrologists, but also for the epidemiologists, medical students, diabetologists and every doctor who deals with diabetes mellitus.

Medical Disorders in Pregnancy - ECAB
Medical Disorders in Pregnancy - ECAB

Author: Hema Divakar

Publisher: Elsevier Health Sciences

Published: 2009-11-15

Total Pages: 194

ISBN-13: 8131232271

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The management of medical disorders in pregnancy has undergone significant changes in the recent years. The pattern of disease has changed with improvements in socio-economic conditions. For example, the incidence of antenatal anemia has decreased progressively in the past few decades, and pulmonary tuberculosis (which used to be prevalent) is now seen only rarely. Chronic rheumatic heart disease has also become less common. On the other hand, gestational diabetes has become more common. This may be due partly to the setting up of screening services for gestational diabetes in many hospitals. The four most common medical disorders complicating pregnancy are anemia, diabetes mellitus, cardiac disease, and thyroid disorders. In addition, because of the improvements in the medical, obstetric, and anesthetic management of pregnancy, many women with medical disorders can go through a pregnancy without major problems. There has also been a progressive decrease in the perinatal mortality associated with some medical disorders, such as diabetes. It is important for all healthcare professionals involved in the management of pregnant women with medical disorders to be conversant with the latest developments in order to provide the best care to these women. The chapters in this issue are certainly helpful in this respect. The eminent authors for the various chapters have discussed the various options available describing in detail their experiences regarding the various aspects of the condition.

End Stage Renal Disease - ECAB
End Stage Renal Disease - ECAB

Author: Ravi Raju Tatapudi

Publisher: Elsevier Health Sciences

Published: 2013-07-16

Total Pages: 205

ISBN-13: 8131232018

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With the increase in lifestyle-related diseases like diabetes and hypertension the prevalence of Chronic Kidney Disease (CKD) is increasing exponentially and with it is increasing the burden of its ominous consequence, End Stage Renal Disease (ESRD). While ESRD is no longer a death sentence with the advent of efficient renal replacement therapies and the success of renal transplantation, factors such as high cost of these procedures, limited availability of donated kidneys and not enough number of centers equipped with these facilities puts the effective management of ESRD beyond the reach of an average person many-a-times. Additionally the presence of co-existing diseases that contribute to and sometimes complicate the renal impairment as well as delayed referral of the patients to nephrologists also makes matters worse. ESRD is not just a medical but also a social and economic condition that devastates the person and his/her entire family. Hence, early detection and effective prevention of progression of CKD in early stages to advanced CKD and ESRD is the call of the day. In fact, understanding the pathophysiology of the condition and adopting methods of primordial prevention in populations at risk may be desirable to ensure reduction in the incidence of CKD. In those with established CKD, a proactive approach to manage the disease manifestations and limit the ravages of other comorbidities is desirable. For those in advanced stages of CKD, the institution of an appropriate renal replacement therapy individually suited to the patient keeping in view the medical status, lifestyle requirements, economic viability and social acceptability should be advised. This book will help the reader understand the intricacies of the aspects mentioned above and guide the practitioner to diagnose and manage End Stage Renal Disease with special reference to practical experience of the same in India. The authors have put together the most relevant facts about the disease for an easy comprehension and understanding of the same by practitioners and students across the specialty.

Portal Hypertension - ECAB
Portal Hypertension - ECAB

Author: Abraham Koshy

Publisher: Elsevier Health Sciences

Published: 2012-06-07

Total Pages: 119

ISBN-13: 813123181X

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Defined as a portal pressure of 12 mmHg or more, portal hypertension results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. Esophagogastric varices is the most important complication of severe portal hypertension because of the high risk of bleeding and mortality associated with them. Ascites is another important complication which may at times be refractory to treatment and may also get complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. Portal hypertension is a predictable and preventable condition but has no definite cure. An aggressive approach to prevention and treatment of portal hypertension is therefore warranted. Treatment of portal hypertension is evolving rapidly and many changes in the therapeutic protocols have been incorporated in recent times. Endoscopic treatment of the bleeding varices and prophylactic role of beta-blockers to prevent rebleeding are well-established therapeutic options. The measurement of the hepatic venous pressure gradient may identify a suboptimal response to beta-blockers in patients at risk of bleeding from varices. However, the costeffectiveness of routine hepatic venous pressure gradient measurements to guide primary prophylaxis has not been examined. Besides these, there is a definite role of somatostatin analogs and shunt surgeries in the treatment of portal hypertension and its complications. This book is designed to update the reader on all such issues related to diagnosis, treatment and complications of portal hypertension along with supportive typical case scenarios. Thus it provides an excellent opportunity to widen one’s perspective in this area.