Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.2
,
N
o
. 1
,
Mar
c
h2
013
,
pp
. 33
~38
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S
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: 225
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8
0
6
33
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urn
a
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o
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: h
ttp
://iaesjo
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r
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o
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x.ph
p
/
IJPHS
Serum Lipid Profile and Electrocardiographic ch
anges in
Young Smokers
U
d
a
y
B. N
ayak,
J
i
nzy
M
a
ri
a
m
Geo
r
g
e
,
Pra
d
eep
T.V
,
N
a
v
een
Department o
f
Medicin
e
, KMCM
angalore,
Manipal University
De
pa
rtme
nt of
Me
dic
i
ne
, JJMC,
D
a
ve
nge
re
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Oct 8,
2012
Rev
i
sed
Jan
3,
20
13
Accepte
d
Ja
n 27,
2013
Smoking represents an important a
nd rapidly growing global cause of
cardiov
as
cula
r m
o
rtalit
y and
m
o
rbidit
y
.
Cig
a
rr
ette smoking is one of the
major modifiable risk factors of
cardi
ov
as
cul
a
r
dis
eas
e,
unles
s
s
m
okers
are
able to qui
t, ap
proxim
a
tel
y
40
% of them
will die prem
ature
l
y.
The need of
the hour
is
timely
interv
ention
th
rough smoking cessation.Ou
r stud
y
was
carried out in
y
o
ung smokers to
demons
trate th
e
effects of smoking on lipid
profile
and electrocard
i
ographic chang
e
s.
W
e
a
i
m
e
d to s
t
ud
y t
h
e eff
ect
of
smoking on lipid profile an
d electrocardio
g
raphic ch
anges in
y
oung
smokers.The stud
y
design
wa
s a c
r
oss se
c
tiona
l
study
c
o
mprising 75 ma
le
smokers and 75
health
y
controls
.Smoki
ng history
and ph
y
s
ical ex
amination
was done .F
asting sample was analy
s
ed for lip
id
profile and
ele
c
troc
ardiogr
a
ph of all s
ubje
c
ts
were re
cor
d
ed.Th
e
s
t
at
is
ti
cal
ana
y
ls
is
between m
ean
values
were
evalua
te
d b
y
student‘t’ tes
t
. Statistical
significance was
assessed b
y
chi-square test,
p
<
0.001 was considered to
be
significant.The mean
pulse
rate, the mean sy
stolic
blood pressure, abnormal
lipid profile and
prolonged Qt interval
were significantly
high
er
in smokers
(p<0.001)
.We dem
onstrated
significan
t
lipid abno
rm
aliti
es and
electrocardiogr
aphic
ch
anges in y
oung
sm
okers
who form an important r
i
sk
group and target population in
whom
smoking cessation
couns
eling
should
be carried out to
decrease
long ter
m
cardiovas
c
ular risk.
Keyword:
Sm
oki
ng
risk facto
r
cardi
ovasc
ul
ar
di
sease
lip
id
pro
f
ile
Copyright ©
201
3 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
DrJi
nzy
M
a
ri
a
m
George
,
Seni
o
r
R
e
s
d
i
e
nt
,
Depa
rt
m
e
nt
of
M
e
di
ci
ne,
R
oom
C
III
4B
,
R
N
E st
a
f
f
q
u
a
r
t
e
rs,
Li
g
h
t
h
ou
se R
o
a
d
,
Man
g
a
l
o
r
e
-
575
001
Em
a
il:j
in
zyg
e
org
e
@g
m
a
il.co
m
1.
INTRODUCTION
Sm
o
k
i
n
g
represen
ts an
im
p
o
r
tan
t
and
rap
i
d
l
y g
r
o
w
i
n
g
g
l
ob
al cau
se
of card
i
o
v
a
scu
l
ar m
o
rtality an
d
m
o
rb
id
ity[1
, 2].W
orldwid
e
,
1.2
b
illio
n p
e
ople sm
o
k
e
d
i
n
20
00
, a
nu
m
b
er th
at is
p
r
oj
ect
ed
t
o
in
crease
to
1.6
b
illio
n
b
y
203
0.[3
]
The earliest epidem
iological study
t
o
dem
onst
r
at
e t
h
e associ
at
i
on
bet
w
een sm
oki
ng a
nd i
s
ch
em
i
c
heart
disease(IHD)
were
the
Fram
ingham
study a
n
d Si
r
Richard
Doll’s cl
assic study
of
British doctors
[4,
5].
C
i
garret
t
e
sm
oki
n
g
i
s
one
o
f
t
h
e m
a
jor m
odi
fi
abl
e
ri
s
k
fact
ors
o
f
ca
rdi
ova
scul
ar
di
sease,
i
n
t
h
e
f
o
rm
of
at
he
roscl
e
ro
si
s an
d
co
ro
nar
y
art
e
ry
disease(CAD ), unles
s
s
m
okers are
ab
le to
q
u
it, ap
pro
x
i
m
a
tel
y
4
0
%
of
them
will di
e prem
aturely.It accelerates the athe
ro
sc
lerotic proce
s
s by its proatherosclerotic and
p
r
o
t
hro
m
b
o
ticactio
n
s
.Acu
te ev
en
ts
su
ch
as
v
e
n
t
ricu
lar
fib
r
illatio
n, and
sud
d
e
n
card
iac d
e
ath
are also
i
n
crease
d
by
sm
oki
ng,
pa
rt
i
c
ul
arl
y
i
n
t
h
e
prese
n
ce
of
pre e
x
i
s
t
i
n
g
cor
o
nary
he
art
di
sease
(
C
H
D
)
by
augm
enting the autonom
i
c syste
m
[3].
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
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6
I
J
PH
S
Vo
l.
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,
No
.
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,
Mar
c
h 20
13
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38
34
The
overall prevalence
of c
u
rre
nt sm
oking
was
15
.5
%(
29
.
3
% am
on
g m
a
les &0
.6
% am
ong
fem
a
l
e
s)
in
Karn
atak
a a
su
rv
ey co
ndu
cted
b
y
ICMR
with
fin
a
n
c
ial sup
port b
y
WHO in
2
000
[4
]
Thu
s
th
e n
e
ed
o
f
t
h
e
h
our is
ti
m
e
ly in
terv
en
tio
n throug
h
sm
o
k
i
n
g
cessatio
n
.
Our st
u
d
y
was carried
out
i
n
y
o
u
n
g
sm
okers t
o
de
m
onst
r
at
e t
h
e effect
s o
f
s
m
oki
ng o
n
l
i
p
i
d
pr
o
f
i
l
e
and
el
ect
rocar
di
o
g
ra
p
h
i
c
chan
ges
,
and
t
h
e pot
e
n
t
i
a
l
benefi
t
s
of
pri
m
ordi
al
preve
n
t
i
on i
n
s
u
ch
po
p
u
l
a
t
i
ons
. To st
udy
t
h
e ef
fect
s of
sm
o
k
i
n
g
on
lipid
pro
f
ile and electr
o
card
i
og
r
a
p
h
i
c ch
an
g
e
s i
n
youn
g sm
o
k
e
r
s
.
2.
R
E
SEARC
H M
ETHOD
The st
u
d
y
desi
gn
was a cr
oss
sect
i
onal
st
ud
y
co
m
p
ri
si
n
g
of
15
0 m
a
l
e
sub
j
ect
s,
75 sm
oke
rs an
d
75
age a
n
d
se
x m
a
t
c
hed
heal
t
h
y
c
ont
rol
s
.
In
cl
u
s
ion
criteria:
Sm
o
k
e
r
s
in th
e ag
e
gr
oup
2
5
-4
0 year
s
wh
o sm
o
k
e
d
fo
r
atleast on
e year.Exclu
sion
criteria:Patien
t
s with
1)
Diabetes m
e
llitus
2)
H
y
p
e
r
t
en
sion
3)
R
e
nal
di
sease
4)
Hepatic diseas
e
5)
Ob
esity
6)
Hi
st
ory
o
f
al
co
hol
a
b
use
7)
Dru
g
s
wh
ich
can
alter lip
i
d
p
r
o
f
ile an
d cau
se ECG abn
o
rm
a
lities
A det
a
i
l
e
d
hi
s
t
ory
wi
t
h
em
phasi
s o
n
d
u
rat
i
on a
n
d
n
u
m
b
er o
f
ci
ga
ret
t
e
/
b
i
d
i
s
sm
oked
was t
a
ke
n
.
Sm
okers
were
di
vi
de
d i
n
t
o
t
w
o
cat
eg
ori
e
s
1)
Depe
n
d
i
n
g on
t
h
e
n
u
m
b
er of y
ears
o
f
sm
oki
ng:
1-
5 y
ear
s
5
-
10
year
s
>1
0 year
s
2)
Depe
n
d
i
n
g on
t
h
e
n
u
m
b
er of ci
garet
t
e
s/
bi
di
s
sm
oked
Li
ght
sm
oke
rs-
1
-
2
0 ci
ga
ret
t
e
/
b
i
d
i
per
day
Heavy
sm
oker
s
>2
0/
day
A
det
a
i
l
e
d ge
n
e
ral
p
h
y
s
i
cal
e
x
am
i
n
at
i
on wi
t
h
vi
t
a
l
si
gns
an
d ca
rdi
ovasc
ul
ar sy
st
em
exam
i
n
at
i
on wa
s
carried out.
B
i
ochemi
cal
a
n
al
ysi
s
B
l
oo
d sam
p
l
e
was t
a
ke
n i
n
f
a
st
i
ng st
at
e fo
r
anal
y
s
i
s
o
f
to
t
a
l ch
o
l
estero
l, LD
L, HDL, trig
lycerid
es,
V LD
L,
whi
c
h was e
s
t
i
m
a
ted by
e
n
zy
m
a
t
i
c
col
o
ri
m
e
t
r
ic
m
e
t
hod.
El
ect
rocar
di
o
g
r
ap
h was t
a
ke
n f
o
r al
l
subjects
a
n
d analysed for any
cardiac
a
b
n
o
r
m
a
li
t
y
i
n
t
e
rm
s of rat
e
, axi
s
de
vi
at
i
on,
co
n
duct
i
o
nde
fect
,
arr
h
y
t
hm
i
a
, ch
am
ber
hy
pert
ro
phy
o
r
c
h
an
ges
su
gg
est
i
v
e
of
i
s
chem
i
a
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
The st
u
d
y
des
i
gn was a cr
o
ss sect
i
onal
st
udy
,
we st
udi
ed 1
50 m
a
l
e
sub
j
ect
s, o
f
w
h
i
c
h7
5 were
sm
okers an
d 7
5
age a
nd se
x
m
a
t
c
hed heal
t
h
y
non sm
oke
rs
.
T
he m
ean age was 3
2
.
0
8 am
o
ng n
o
n
sm
okers an
d
31
.9
3 i
n
sm
okers. T
h
er
e was
no
di
f
f
ere
n
ce
not
i
c
e
d
am
ong t
h
e
gr
o
u
p
s
wi
t
h
re
fere
nce
t
o
di
et
an
d
p
h
y
s
i
cal
activ
ity.
D
i
str
i
bu
tio
n acco
rd
ing
to num
b
e
r
o
f
years o
f
sm
o
k
i
ng
an
d nu
m
b
er
of
cig
a
r
e
tte p
e
r
dayO
f
th
e 75
sm
okers,
34 s
u
bject
s sm
oke
d
upt
o 2
0
ci
ga
ret
t
es/
d
ay
fo
r 5
-
1
0
y
ears
(
4
3
.
3
%
)
, 1
6
sm
oke
d f
o
r
1-
5 y
ears
(
2
1
.
3
%)
and
8 sm
oked
for m
o
re t
h
an
10 y
ears(
1
0
%
)
.
17 s
u
b
j
ect
s s
m
oked
m
o
re t
h
an
20 ci
ga
ret
t
e
s for m
o
re t
h
an 1
0
years(22.6%
)
Statistica
l Ana
l
y
s
is
The
di
ffe
re
nce
s
bet
w
ee
n m
ean
val
u
es
wer
e
eval
uat
e
d by
st
ude
nt
‘t
’ t
e
st
.
The st
at
i
s
t
i
cal
si
gni
fi
ca
nce
w
a
s assessed by u
s
ing
ch
i-
squar
e
test,
p
<
0.00
1 w
a
s co
n
s
i
d
er
ed to
b
e
si
g
n
i
fican
t.
The m
ean puls
e rate wa
s
higher i
n
sm
oker
s
8
1
.
1
6
vs
7
4
.
8
1, t
h
e m
ean sy
st
ol
i
c
bl
o
o
d
pr
essur
e
wa
s
si
gni
fi
ca
nt
l
y
hi
ghe
r i
n
sm
oker
s
1
2
4
.
1
9
vs
1
1
5
.
9
7
i
n
n
o
n
sm
oke
rs
(p<
0
.
0
01
) Ta
bl
e 1
.
The l
i
p
i
d
p
r
o
f
i
l
e am
ong sm
okers
were c
o
m
p
arat
i
v
el
y
hi
g
h
e
r(
p<0
.
0
0
1
) t
h
an i
n
n
on sm
okers
, wi
t
h
a
l
o
we
r H
D
L l
e
vel
am
ong sm
oke
rs.
A
l
s
o
as t
h
e d
u
r
at
i
on
o
f
sm
oki
ng a
nd
n
u
m
b
er of
ci
gar
e
t
t
e
s i
n
creased
so
di
d
th
e lip
id
abno
rmali
ties (Figu
r
e 1).
Evaluation Warning : The document was created with Spire.PDF for Python.
IJP
H
S
in
ter
v
diffe
r
S
Figur
e
The Qt i
n
v
al was redu
c
e
n
ce in P
wa
v
T
T
e
1.
De
pi
ct
s a
s
n
terval was
p
c
ed
am
o
ng
s
v
e,
Q
R
S
c
omp
l
Fi
gu
re 2.
I
T
itle o
f
ma
nu
s
T
able 1.Corel
a
s
t
h
e
d
u
rat
i
on
p
ro
long
ed
a
m
s
m
okers b
u
t
l
ex, T a
n
d
S
T
Qt i
n
terval
w
SSN
:
225
2-8
8
s
crip
t is sh
o
r
t
a
t
i
on bet
w
ee
n
of
sm
o
k
i
ng i
n
m
ong s
m
oker
s
no
t statistic
a
T
se
gm
ent ch
a
w
as pr
ol
on
ge
d
8
06
an
d clea
r
, i
m
n
Pu
lse rate a
n
n
crease
s
s
o
d
o
s
39
1.
8
5
±
3
5
a
lly sig
n
i
fica
n
a
nge
s (
F
i
g
ure
2
in sm
okers
V
m
pli
e
s rese
ar
c
n
d B
P
o
es lip
i
d
ab
n
o
V
s
369
.0
3±3
n
t
n
e
ith
er
w
a
2
).
V
s no
nsm
oker
s
c
h resu
lts (Fi
r
o
rmali
ties).
0.68
(p
<0
.0
01
a
s there
a
n
y
s
r
st Author)
35
), the PR
stat
istica
l
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
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6
I
J
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S
Vo
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2
,
No
.
1
,
Mar
c
h 20
13
:
33–
38
36
4.
DIS
C
USSI
ON
Ciagarette smoki
ng is re
port
ed to be
assoc
i
ated
with
a
n
avera
g
e 70%
i
n
creas
e
in t
h
e
risk
of deat
h
fr
om
corona
ry
art
e
ry
di
seas e[
6]
. It
has bee
n
obs
er
ved
th
at sm
o
k
i
n
g
affects lip
id
p
r
ofile an
d
in
creases the risk
of ca
rdi
ova
scular death.T
hus
m
easurem
ent of lipi
d
pr
o
f
i
l
e in
clin
ical l
a
b
o
rato
ry has
becom
e
increa
singly
im
portant beca
use of
pre
d
ictive
ass
o
cia
tion
with
co
ron
a
ry h
eart d
i
sease [7
].
In a st
udy
c
o
n
duct
e
d by
C
r
ai
g et
al
i
t
was o
b
ser
v
e
d
that young sm
okers
are relatively at a highe
r
ri
s
k
of de
vel
opi
ng
cardi
ovasc
ul
ar
di
sease (C
V
D
)
com
p
ared t
o
ol
der ad
ul
t
s
[
7
]
,
our st
u
d
y
com
p
ri
sed of s
u
b
j
ect
s
were i
n
t
h
e a
g
e gr
o
up
2
5
-
3
0,
t
h
ey
fo
rm
t
h
e pr
o
duct
i
v
e
work force of the society
and hence we
re
studied
to
reflect th
e im
p
act it
m
i
g
h
t
h
a
v
e
with
resp
ect
to
ca
rdi
ovasc
ular disease
and
econom
i
c burden in future.
In
o
u
r st
udy
s
m
okers ha
d a
si
gni
fi
ca
nt
l
y
hi
ghe
r
pul
se
rat
e
and
sy
st
ol
i
c
b
l
oo
d
press
u
r
e
com
p
ared t
o
no
n sm
oker
s
.
N
i
c
ot
i
n
e a
n
d o
n
e o
r
m
o
re t
o
xi
c age
n
t
s
i
n
cig
a
rette sm
o
k
e
are im
p
licate
d
in
the p
a
t
h
og
en
esis.
Al
t
h
o
u
g
h
t
ach
y
cardi
a
du
ri
n
g
sm
oki
ng c
o
nt
ri
but
es
t
o
i
n
crea
se i
n
bl
o
o
d
pre
ssure
,
ot
he
r m
echani
s
m
s
by
whi
c
h
ci
garet
t
e
sm
o
k
i
n
g m
a
y
raise bl
o
od
pre
ssure i
n
cl
u
d
e
α
1 adre
no
re
cept
o
r m
e
di
ated vas
o
c
onst
r
i
c
t
i
on,
vas
o
pressin rel
ease and
possi
ble di
rect
effects on
en
do
th
eli
a
l fun
c
tion
[
8
]
.
Ab
n
o
rm
al
li
pi
d l
e
vel
s
an
d sm
oki
ng are t
h
e t
w
o m
o
st
im
port
a
nt
ri
s
k
fact
ors f
o
r h
a
vi
n
g
a heart
attack
[4
].
High cho
l
estero
l lev
e
ls are esti
m
a
ted
to
cau
s
e
56%
of isc
h
em
ic heart
disease
and 18%
of st
rokes,
a
m
o
u
n
ting
t
o
4
.
4
m
i
llio
n
d
e
ath
s
annu
ally[
9
]. In
our
study w
e
fo
und
that s
m
o
k
e
r
s
h
a
d
sign
if
ican
tly
h
i
gh
er
lev
e
l o
f
lip
id
ab
norm
a
l
ities
an
d
a lo
wer
HDL. Direct relatio
n
s
h
i
p
o
f
s
m
o
k
i
n
g
toward
s CHD h
a
s b
e
en
men
tio
n
e
d
i
n
MRFIT trial, it was d
e
scrib
e
d
th
at in
creas
e
in HDL 1m
g/dl was associ
ate
d
with
dec
r
eas
e in the
ri
sk
of C
H
D
[
10]
.T
he i
n
ci
d
e
nce o
f
devel
opi
ng C
V
D i
s
di
rect
l
y
rel
a
t
e
d t
o
t
h
e
n
u
m
b
er of
ci
g
a
ret
t
e
s
sm
oked[
11]
.
I
n
ou
r st
u
d
y
we
were a
b
l
e
t
o
s
h
ow a
di
rect
co
r
r
el
at
i
on
bet
w
ee
n d
u
rat
i
on a
n
d num
ber
of ci
ga
ret
t
e
s
sm
oked wi
t
h
t
h
e m
a
gni
t
ude
of
dy
sl
i
p
i
d
em
ia. These res
u
l
t
s were i
n
co
n
f
orm
i
t
y
wi
t
h
a
st
udy
co
n
duct
e
d by
Ra
m
achandra
n
et al[12].
Sm
o
k
i
n
g
is al
so
k
now
n
t
o
in
du
ce au
tonomic ch
an
g
e
s an
d
m
a
y p
r
ecipitate ar
r
h
yth
m
i
a
s and
sudd
en
cardi
ac
deat
h.
In
ou
r st
u
d
y
t
h
e QTc
was
fo
u
nd t
o
be
p
r
ol
on
ge
d am
ong sm
oke
rs, t
h
i
s
m
a
y i
n
crease t
h
e
th
r
e
sh
o
l
d
f
o
r
ar
rh
yth
m
ias, and
Q
T
c
p
r
o
l
ongatio
n
m
a
y d
oub
le th
e r
i
sk
for sudd
en card
i
ac d
eath as
studied
b
y
Oki
n
PM
et al[13].
Thu
s
th
is study d
e
m
o
n
s
tr
ated
sign
if
ican
t l
i
p
i
d
abno
r
m
ali
ties an
d
electro
card
i
og
r
a
ph
ic ch
ang
e
s in
y
o
u
ng sm
oke
r
s
wh
o f
o
rm
an i
m
port
a
nt
ri
sk g
r
o
u
p
an
d
a t
a
rget
p
o
p
u
l
a
t
i
on i
n
w
h
o
m
sm
oki
ng ce
ssat
i
o
n
cou
n
sel
i
n
g s
h
o
u
l
d
be ca
rri
e
d
out
t
o
d
ecreas
e
long te
rm
cardiovasc
ular
risk.
5.
CO
NCL
USI
O
N
I
n
a co
un
tr
y lik
e ou
rs wh
ere
t
obacc
o re
pres
ent
s
an i
m
port
a
nt
cash cr
o
p
a
nd a s
o
urce
of
em
pl
oym
ent
,
t
w
o t
h
i
n
g
s
t
h
at
are o
f
t
e
n i
n
s
h
o
r
t
su
p
p
l
y
, t
h
e sm
oki
ng rat
e
s am
ong m
e
n are st
ag
geri
ngl
y
hi
gh
. I
f
t
h
e c
u
r
r
ent
sm
oking pattern continues by
2030 the
gl
obal burde
n of di
sease attributa
b
le
to tobacco
will
reach 10
mil
lion
d
eath
s
ann
u
a
ll
y, th
u
s
p
r
even
tio
n
t
h
rou
gh h
ealth
edu
cat
io
n
is im
p
e
rativ
e to
bring
do
wn
m
o
rtality
an
d
m
o
rbi
d
i
t
y
due
t
o
car
di
o
v
asc
u
l
a
r
di
sease c
ont
ri
b
u
t
e
d t
o
by
s
m
oki
ng.
ACKNOWLE
DGE
M
ENTS
We th
an
k
th
e
statistician
,
Dr. Ko
tian, Dep
a
rt
m
e
n
t
o
f
Co
mm
u
n
ity
Med
i
ci
n
e
, KMCm
an
galo
re and
the
pat
i
e
nt
s f
o
r t
h
e
i
r val
u
abl
e
c
o
n
t
ri
but
i
o
n t
o
ou
r
st
u
d
y
.
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BIOGRAP
HI
ES OF
AUTH
ORS
Dr B Uday
Nay
a
k, Associate Profe
ssor, Department
of
Medicine KMC
Ma
nga
lore,
Ma
nipa
l Unive
r
sity
.
Dr. Jinzy
Mar
i
am George,
Senior Re
si
d
e
nt
,
De
pa
r
t
me
n
t
of Medicine,
KMCMangalore, Manip
a
l University
.
Dr.
Pra
d
ee
p
TV, Assista
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tProfe
sso
r, Medicine, JJ
MC, Daveng
ere.
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52-
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2
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No
.
1
,
Mar
c
h 20
13
:
33–
38
38
Dr.
Naveen, Post Gradua
te, Dep
a
rtment of
Medi
cineKMC MangaloreManipal
University
.
Evaluation Warning : The document was created with Spire.PDF for Python.