Prevalence of coronary risk factors in non-insulin dependent (type 2) diabetics

OBJECTIVES

A cross sectional study was conducted to find the prevalence of coronary risk factors in non-insulin dependent diabetic (NIDDM) patients and to compare and co-relate these risk factors in type II diabetics with and without electrocardiographic and/or symptomatic evidence of coronary heart disease (CHD).

METHODS

One hundred sixty-seven consecutive NIDDM patients (77 males, and 90 females) attending the diabetic clinic at Dr. RML Hospital, New Delhi were studied. Only known NIDDM cases, already on treatment and without any history of ketosis or congestive heart failure were included. Coronary risk factors comprising of age, gender, duration and treatment for diabetes, smoking, physical activity, hypertension, truncal obesity, lipids, microalbuminuria (semiquantitative) and glycemic control have been particularly ascertained in all the cases. The data was analysed using 'Epi Info version 6.0'.

RESULTS

The mean age of patients was 53.12 year and 8.86 year was the mean duration of diabetes. 28.6% of the diabetic men were found to be currently smoking and/or consuming alcohol, 82% were involved in sedentary physical activity and 20.4% had family history of CHD. Central obesity was observed in 46.7% of the cases; more so in females. 31.74% of cases were hypertensive; more females than males had hypertension (33.8% vs 30%). Poor glycemic control (HbA1c > = 9.5%) was seen in 16.8% of the cases. In about 52.5% of the total group hypertriglyceridemia was noted. Microalbuminuria could be found in 35.93%. CHD was diagnosed in 15.57% of cases in this study.

CONCLUSIONS

The present study revealed that high levels of serum cholesterol (p = 0.000004), LDL (p = 0.00003), HbA1c (p = 0.002), microalbuminuria (p = 0.000006) and hypertension (p = 0.00006) are significant associates of CHD in NIDDM (both the sexes). Among the female NIDDM cases, in addition BMI (p = 0.01), Waist-hip ratio (WHR) (p = 0.003) and low HDL level (p = 0.008) are important correlates of CHD. Multiple logistic regression analysis was used to allow for confounding between variables. Microalbuminuria alone entered the 'best' model for CHD prediction. Other risk factors, though significant, provided inadequate models for CHD prediction.

Percutaneous balloon aortic valvuloplasty during pregnancy: use of the Inoue balloon and the physiologic antegrade approach

We describe the use of the Inoue balloon to dilate the aortic valve by the physiologic antegrade route during pregnancy. A 27-year-old pregnant woman with severe aortic stenosis presented with progressive dyspnea and presyncope at 26 weeks of pregnancy. She subsequently underwent percutaneous valvuloplasty by the antegrade route utilizing the transseptal puncture. We conclude that percutaneous antegrade balloon valvuloplasty by the Inoue balloon (venous approach) is a safe and effective procedure. It markedly reduces fluoroscopy and is a palliative procedure that allows pregnancy to continue.

Fertility outcome after reversal of sterilization

OBJECTIVE

The study was designed to evaluate the fertility outcome in sterilization reversals and a variety of factors that have been suggested to influence the successful outcome of sterilization reversal procedures.

METHOD

It is a retrospective study involving all sterilization reversals performed between January 1991 and December 1995 in our hospital. A total of 58 cases were treated. Tubal anastomosis was performed according to rules of microsurgery. The loupe microsurgical technique with 4 x magnification comprising two main phases, preparation of healthy tubal segments and anastomosis carried out in two layers.

RESULTS

It was possible to study subsequent fertility of 50 patients in all, as 8 patients were lost to follow-up (13.76%). The overall conception rate was 68% (34 cases), out of which intrauterine pregnancy rate was 62% (31 cases), ectopic pregnancy rate was 6% and the abortion rate was 6%. Fifty percent of patients conceived within first 12 months of reversal of sterilization. The isthmic-isthmic type of anastomosis has maximum incidence of pregnancies (88.88%).

CONCLUSION

Laparoscopic (Falope ring) sterilization should be preferred in women who are willing for interval sterilization and it should be done at isthmic segment of the tube, whereas the Pomeroy's method is to be reserved for occasional postpartum procedure. Reversal of sterilization should be done with strict adherence to principles of microsurgery.

Acute haemodynamic effects of nicorandil in patients with chronic severe regurgitant valvular lesions

The haemodynamic effects of nicorandil, a new balanced vasodilator exhibiting nitrate-like as well as potassium-channel opening activity in patients with chronic severe valvular lesions have not been reported. We studied the acute effect of nicorandil on haemodynamics in 12 stable patients (6 males, 6 females; mean age 23.5 +/- 4.6 years) with chronic severe valvular regurgitation (8 mitral, 4 aortic). All patients were studied in resting, supine and fasting states. All cardioactive drugs were withdrawn five days prior to the study. Intra-arterial line was placed and thermodilution catheter was positioned in the pulmonary artery. Haemodynamic parameters recorded at baseline and at 30, 60, 90 and 120 minutes following a single oral dose of 20 mg nicorandil revealed no significant change in the heart rate while systemic pressures showed a small decline (p < 0.05). There was significant reduction in systolic, diastolic and mean pulmonary artery pressures (p < 0.001). The mean cardiac index increased from 3.16 L/min/m2 at baseline to 3.77 L/min/m2 at 60 minutes. Both the pulmonary and systemic vascular resistance indices reduced significantly, the peak fall being 18 percent and 29 percent, respectively. Maximal changes were observed at 60 to 90 minutes following administration of nicorandil. No adverse effect of nicorandil occurred during the study. We conclude that nicorandil has a favourable acute haemodynamic effect in patients with chronic severe valve regurgitation. Its long-term use in valvular lesions should be explored further.

Prevalence of NIDDM in the general population (> 40 years) in Shimla

A random survey for determining the prevalence of NIDDM was conducted in the population aged 40 years and above of Shimla town. 1195 subjects were screened for estimation of NIDDM prevalence from seven randomly selected wards. The prevalence of NIDDM in age group 40 years and above was 4.86% (5.17% in males and 4.38% in females). NIDDM was found to be positively associated with increasing age, BMI, WHR, family history of diabetes and negatively with physical activity. Stress should be on early detection of diabetes to reduce the heavy burden of morbidity and mortality caused by diabetes.

Hypertensive disorders of pregnancy and maternal and foetal outcome: a case controlled study

A case controlled prospective study of 250 cases of hypertension complicating pregnancy (study group) and 400 normal pregnant women (control group) was carried out to determine the effect of hypertension on maternal and foetal outcome. Pregnancy induced hypertension was present in 96% cases and chronic hypertension in 4% cases. Preterm delivery (28.8% versus 3%), labour induction rate (52.8% versus 3.25%), caesarean section rate (14.8% versus 3.5%), stillbirth rate (4.8% versus 0.25%) and overall perinatal mortality rate (14.8% versus 1%) were higher in study group compared to controls. In study group (40%) babies required special nursery care compared to controls (6.75%). From these results it can be concluded that maternal hypertension is associated with adverse pregnancy outcome.

Comparative evaluation of fine needle aspiration cytology and biopsy of testis in diagnosis of male infertility

Infertility has a fair degree of male factor contribution in its aetiology, hence needs complete evaluation of male partner especially the status of spermatogenesis. In the present study comparative evaluation of fine needle aspiration cytology (FNAC) and biopsy of testis showed 90% accuracy of FNAC in respect of histopathological diagnosis of spermatogenesis. FNAC is a safe, fairly accurate, outdoor investigation in infertile man and it is devoid of the complications of haematoma formation, suppression of spermatogenesis and antigenic stimulation as seen with testicular biopsy.

In vitro effect of gold sodium thiomalate and methotrexate on tumor necrosis factor production in normal healthy individuals and patients with rheumatoid arthritis

We studied the in vitro action of gold sodium thiomalate (GSTM) and Methotrexate (MTX) on spontaneous and lipopolysaccharide (LPS) stimulated TNF alpha production by peripheral blood mononuclear cells (PBMC) of patients with rheumatoid arthritis (RA) and normal healthy individuals. GSTM and MTX (10 microg) each were added to the cultures of PBMC either in medium alone (spontaneous) or in the presence of 10 microg of LPS. GSTM and MTX augmented spontaneous TNF alpha production in normal individuals and patients with RA but did not influence LPS stimulated TNF alpha production. However, TNF alpha production by the PBMC of normal individuals was inhibited if the PBMC were stimulated with LPS, for 6 or 12 h, washed to remove LPS and subsequently incubated with GSTM. These data indicate that GSTM can inhibit TNF alpha production when the PBMC are preactivated by LPS.

Anthropometric data of Indian farm workers--a module analysis

Anthropometric data of Indian farm workers have been compared with various other ethnic groups. The analysis indicates that there is a significant difference in the body dimensions which must be taken into account in designing farm equipment.

Study of pulmonary functions in swimmers of Lucknow city

In this study, the pulmonary functions of young swimmers of K.D. Singh Babu Stadium, Lucknow were studied, 20 swimmers of the age group of 15-20 years were chosen along with 15 students as controls. The parameters taken into account were Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1) and Peak Expiratory Flow Rate (PEFR). Two sets of readings were recorded. One before the start and the other at the end of the practice season. These readings were compared to each other and also with the values of the controls. The results indicate that swimming has considerable effect on enhancing lung functions of an individual as FVC, FEV1, PEFR were significantly raised in swimmers after swimming session. Such results suggest that swimming may be induced in the exercise programme for rehabilitation of respiratory patients who have compromised lung functions.

An extracellular phosphatase from Aspergillus fumigatus

A potential producer of extracellular phosphatase has been isolated and identified as A. fumigatus. The fungal phosphatase is active in pH range 5 to 8 and its temperature optimum is 65 degrees C. The mineralisation of organic phosphates present in Neem cake and press mud by this enzyme has been demonstrated.

Evidence for high prevalence & rapid transmission of HIV among individuals attending STD clinics in Pune, India

Prevalence and incidence of HIV-1 infection among persons attending two STD clinics in Pune between May 1993 and October 1995 are reported. On screening 5321 persons, the overall prevalence of HIV-1 infection was found to be 21.2 per cent, being higher in females (32.3%) than in males (19.3%). Analysis of behavioural and biological factors showed that old age, sex work, lifetime number of sexual partners, receptive anal sex, lack of circumcision, genital diseases and lack of formal education were related to a higher HIV-1 seroprevalence. The observed incidence rate of 10.2 per cent per year was very high, much higher in women than in men (14.2% and 9.5% per year respectively) and over three times higher among the sex workers. Females in sex work, males having recent contacts with female sex workers (FSWs) and living away from the family and persons with previous or present genital diseases had a higher risk of seroconversion. Condom usage was shown to have a protective effect in seroprevalence and seroincidence analysis. With limited available resources and lack of a suitable vaccine or a drug, long-term prevention policy of creating awareness in the community must be supplemented by strengthening STD control measures and promotion of condom use and safe sex. Factors related to availability and utilization of condoms must be carefully investigated.

Abdominal tuberculosis in Indian children

During the period 1980-1991, 166 cases (121 surgically explored and 45 treated conservatively) of abdominal tuberculosis in children were encountered at the Children's Hospital, Institute of Medical Sciences, Banaras Hindu University. Various types of presentations and their management are discussed in the light of pertinent literature.

IgE levels of normal Indian children

A number of factors, including age, sex and atopic status have been reported to influence levels of serum IgE. Serum samples were obtained from 350 (173 males, 177 females) non allergic normal Indian children of 0-15 years of age. Mean serum IgE value was 65.8 +/- 4.0 IU/ml being significantly higher in males (75.0 +/- 2.7 IU/ml) as compared to females (56.6 +/- 3.0 IU/ml). The levels were found to increase with age irrespective of sex.

Volvulus of the caecum caused by injury

A case of acute caecal volvulus of obstructive type following an injury is described. The literature has been briefly reviewed.

The management of renal and ureteric calculi in renal failure

The management of 50 patients with renal failure and renal and ureteric calculi is described. Following dialysis and appropriate surgical intervention, renal function improved in 86%. Patients with acute and acute on chronic renal failure improved to nearly normal and remained so on follow-up. Eight per cent of those treated by surgery had retained calculi and 2% developed a recurrence of stones. Sixty-eight per cent showed improvement in hypertension. The mortality rate was 8%.