Status of iodine deficiency in district Kangra, Himachal Pradesh after 60 years of salt iodization

BACKGROUND/OBJECTIVES

District Kangra, Himachal Pradesh(HP), India is a known endemic area for iodine deficiency disorders (IDD) since 1956. The present study was conducted in district Kangra, Himachal Pradesh with the objective to assess the prevalence of iodine deficiency in school-age children.

SUBJECTS/METHODS

A total of 1864 children in the age group of 6-12 years were included. Clinical examination of thyroid of all children was undertaken. 'On the spot' urine samples were collected from 463 children. The salt samples were collected from 327 children.

RESULTS

The total goiter prevalence of 15.8% was found. The proportion of children with urinary iodine excretion (UIE) levels <50.0, 50.0-99.9 and ≥ 100 μg/l was 2.2, 14.3 and 83.5%, respectively. The median UIE level was 200 μg/l. About 82.3% of the families were consuming salt with iodine content ≥ 15 ppm.

CONCLUSION

The population in district Kangra is possibly in a transition phase from iodine deficient (as revealed by total goiter rate of 15.8%) to iodine sufficiency (as revealed by median UIE levels of 200 μg/l).

Biotechnological advances in amaranths species and their future outlook in crop improvement--a review

The grain amaranths were important food crops for the ancient middle and South American civilization. The germplasm of amaranths also has not been well characterized from the point of view of its exploitation for improvement of amaranths in general, a grain amaranth in particular. Among all under exploited crops grain amaranth is the most suitable candidate to begin with. As it is one of the most important under exploited crops being used as subsidiary or supplementary food. This work will report a study concerning the patent related to the biotechnological applications of Amaranths. It has been summarized in results that RAPD is a powerful approach to understand both inter-as-well as intra species relationships in the genus amaranths. One result indicates the presence of at least two repetitive families, such that at least one family of sequences is present in both cot1 as well as total nuclear DNA. The grain amaranth cultivation plays an important role in changing the economy of rural life. It is a source of dietary protein in strictly vegetarian people. In amaranths, somatic hybridization can be combined to the tertiary gene pools. Some of amaranth triploids are reported to be good in (Sharma SK, Dawson IK and Waugh R 1995) foliage and nutritional quality. They have broader leaves and good growth. Amaranth is grown under variety of soils and environmental conditions such as alkalinity, salinity, drought, frost etc. One of the ways to improve quality of grain amaranths to isolate variants of lysine genes products of which are enriched in essential amino acids. The high lysine content gene named as 'amargene' has been isolated and the patents have been used as biotechnological approach to introduce the gene in the tuber crop improvement The scope of biotechnology for the genetic improvement of grain amaranth crop has been described.

Delayed resolution of inflammatory response compared with clinical recovery in patients with acute exacerbations of chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVE

The temporal profile of inflammatory markers during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and their relationship to clinical response are not well characterized. The aim was to assess the changes in levels of inflammatory markers in AECOPD and correlate these with clinical and laboratory indices of recovery.

METHODS

Serum levels of C-reactive protein (CRP), interleukin (IL)-6 and fibrinogen were measured in patients with AECOPD within 24 h of hospitalization and pre-discharge (stable state).

RESULTS

Ninety-seven patients were evaluated (79 males; mean (SD) age, 61.4 (10.3) years). Eighty eight (90.7%) were current or former smokers, with a median consumption of 15 (0-75) packs/year. The median duration of COPD was 8 (2-25) years. Forty-six patients (56.9%) required mechanical ventilation for a median of 5 days (1-34) while in hospital. The median duration of hospital stay was 13 days (1-77). At reassessment before planned discharge, the levels of dyspnoea, leucocyte counts, erythrocyte sedimentation rate, creatinine, partial pressure of oxygen, and albumin normalized. The levels of CRP, IL-6 and fibrinogen reduced significantly but did not reach the normal range. Changes in IL-6 and fibrinogen levels correlated significantly with the acute physiologic assessment and chronic health evaluation II score, smoking history, blood pressure and leucocyte counts. Baseline IL-6 and fibrinogen levels significantly predicted a prolonged duration of mechanical ventilation.

CONCLUSIONS

During AECOPD, the inflammatory response lags behind clinical and biochemical improvement. Fibrinogen and IL-6 are potentially useful markers for monitoring clinical response following an acute episode.

Relative efficacy of weekly and two differing doses of daily iron-folate supplementation in improving hemoglobin in mild and moderately anemic children between 3 and 5 years of age: a cluster randomized trial

BACKGROUND/OBJECTIVES

In India, 75% of children <5 years of age have anemia. The National Nutritional Anemia Control Program (NNACP) recommends 20 mg iron and 100 μg folic acid (IFA) supplementation for 100 days/year, but still anemia prevalence has remained high. To accelerate the progress, suggestions include increase in IFA to therapeutic dose or supervised weekly supplementation to improve compliance. The objectives of this study was to compare the hemoglobin response with two dosages of daily (20 mg iron and 100 μg folic acid, or 40 mg iron and 200 μg folic acid) and weekly (40 mg iron and 200 μg folic acid) IFA supplementation in children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl).

SUBJECTS/METHODS

Community-based cluster randomized control trial in nine adjoining Anganwadi Centers. Four hundred twenty six enrolled participants received directly supervised IFA tablet supplementation as per the above three groups. After 100 days, the number of available subjects in the NNACP daily dose (A), daily dose doubled (B) and weekly dose (C) groups were 112, 114 and 110, respectively. Hemoglobin was estimated at baseline, 50 and 100 days by the Cynmeth hemoglobin method.

RESULTS

At 50 days, there were no differences between the three groups, but at 100 days, adjusted hemoglobin was lowered with weekly supplementation. The mean (95% confidence interval) hemoglobin (g/dl) differences were: (i) A-B: -0.05 (-0.17, 0.05), (ii) A-C: -0.38 (-0.50, -0.27) and (iii) B-C: -0.33, (-0.45, -0.21). Anemia reduction was 18.8%, 18.4% and 10.9%, respectively, in the three groups.

CONCLUSION

Directly supervised IFA supplementation at the NNACP or double dose is equally efficacious but superior to weekly regimen.

Role of simvastatin in prevention of vasospasm and improving functional outcome after aneurysmal sub-arachnoid hemorrhage: a prospective, randomized, double-blind, placebo-controlled pilot trial

BACKGROUND

Vasospasm plays a major role in the morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The preliminary studies suggest that statins protect against cerebral vasospasm.

OBJECTIVE

The aim of the study was to determine the role of simvastatin in preventing clinical vasospasm and improving functional outcome in patients with aSAH.

METHODS

All patients with aSAH admitted within 96 h of ictus were randomized to receive either Simvastatin or placebo - 80 mg/day for 14 days. Thirty eight patients were recruited in the study- 19 received Simvastatin and 19 placebo. All the patients underwent surgical clipping of the aneurysm. The primary outcome of the study was the development of clinical cerebral vasospasm. The secondary outcomes included Glasgow Outcome Score (GOS), Modified Rankin Scale (MRS) and Barthel Index Score (MBI) at follow-up at 1, 3 and 6 months.

RESULTS

16% of the patients in the simvastatin group had high Middle Cerebral Artery velocities (> 160 cm/sec) on transcranial Doppler on one or more than one day during the study duration as compared to 26% of the patients in the placebo group (p = 0.70). Neurological deterioration occurred in 26% and 42% of the patients in simvastatin group versus placebo group, respectively (p = 0.31). There was an improvement in the functional outcome in the simvastatin group at 1, 3 or 6 months in the follow-up; however, this difference was not statistically significant.

CONCLUSIONS

There was benefit of simvastatin in terms of reduction in clinical vasospasm, mortality or improved functional outcome, however, this was not statistically significant.

Type-specific incidence and persistence of HPV infection among young women: a prospective study in North India

BACKGROUND

Infections with human papillomavirus (HPV) are highly prevalent among sexually active young women in India. However, not much is known about the incidence of type-specific human papillomavirus (HPV) infections and their patterns of persistence, especially in the Indian context.

OBJECTIVE

The objective of this study was to evaluate the rate of acquisition and persistence of HPV types in young women.

METHODS

Women residing in an urban slum in Delhi (n=1300) were followed for 24 months at 6 monthly intervals. Exfoliated cervical cells collected at each visit were tested for the presence of HPV DNA. Genotyping was performed using the reverse line blot assay.

RESULTS

The incidence rate for any HPV type was calculated to be 5 per 1000 women-months. Among high risk HPV types, HPV16 had the highest incidence rate followed by HPV59, HPV52 and HPV18, i.e., 3.0, 0.58, 0.41 and 0.35 women per 1000 women-months respectively. The persistence rate was higher for high-risk than low-risk HPV types. Among low-risk types, HPV42, HPV62, HPV84 and HPV89 were found to persist. Whereas almost all high risk types showed persistence, the highest rate was found in women with HPV types 16, 45, 67, 31, 51 and 59. The persistence rate for HPV16 infection was 45 per 1000 women-months.

CONCLUSION

Incident HPV infections and high risk HPV type-specific persistence were found to be high in our study population of young married women. Understanding the patterns of HPV infection may help plan appropriate strategies for prevention programs including vaccination and screening.

Changes in the metabolome and histopathology of Amaranthus hypochondriacus L. in response to Ageratum enation virus infection

Amaranthus hypochondriacus L. infected with Ageratum enation virus (AEV) was investigated for identifying alteration in the anatomical structures, sap translocation and metabolomic variations using light microscopy, magnetic resonance imaging, NMR spectroscopy and GC-MS, respectively. Combination of GC-MS and NMR spectroscopy identified 68 polar and non-polar metabolites that were present in different levels in healthy and virus-infected A. hypochondriacus. Contrast of T₁ and T₂ weighted MR images showed significant differences in the spatial distribution of water, lipids and macromolecules indicating alterations in the cortical region and disruption of vascular bundles in virus-infected stem tissues. MRI observations are supported by light microscopic examination. Microscopic examination of AEV infected stem revealed severe hyperplasia with a considerable reduction in size of stem cells. The NMR spectroscopy and GC-MS analysis indicated that viral infection significantly affected the plant primary and secondary metabolism resulting in decreased glucose and sucrose content and increase in the concentration of β-sitosterol and stigmasterol. Higher accumulation of TCA cycle intermediates such as citric acid and malic acid in AEV infected plants indicated enhanced rate of respiratory metabolism. The viral stress significantly increases the concentration of erythritol and myo-inositol as compared to healthy ones. Lower concentration of glucose and sucrose in viral-infected stem tissues suggests decreased translocation of photosynthates in the plants. The results demonstrated potential of MRI, NMR spectroscopy and GC-MS for studying anatomical and metabolic variations in virus-infected plants.

Normative data for anthropometric parameters used in delineation of dysmorphic features in north Indian children

OBJECTIVE

To provide normative data for a set of anthropometric parameters which are commonly used in delineation of dysmorphic features.

METHODS

This cross-sectional observational study was conducted in a tertiary care hospital of Delhi. Six hundred infants and children up to 2 years with hundred subjects each in the age group of 0-3, 3-6, 6-9, 9-12, 12-18 and 18-24 months were included. Both sexes were represented equally in the sample to avoid bias. Inner and outer intercanthal distance were measured by sliding callipers. Inter pupillary distance was measured directly as the distance between midpoint of two pupils. Ear length was the maximum vertical distance from the superior to the inferior edge of the ear. Internipple distance was the distance between centre of both nipples. Hand length was the distance between distal wrist crease to the tip of middle finger. Middle finger length was the distance between proximal flexion crease and tip of middle finger. The data was analyzed using the LMS method and percentile curves were developed for each age group for all the seven parameters.

RESULTS

No statistically significant differences between male and female infants were observed. Significant differences were observed from other south east Asian and Caucasian population stressing the need for generation of regional ethnic data. The percentage of other isolated anomalies noted was 1.16% for polydactyly, 2-4 syndactyly 2-4 toe syndactyly (0.89%), Preauricular tags (0.5%), double whorl pattern of hair (1.55%), 2-4 syndactyly (0.33%) and paraumbilical hernia (2.83%).

CONCLUSIONS

Normative data directed towards the ethnic origin are useful in charting dysmorphic traits. Children with parameters less than 3rd percentile or more than 97th percentile should be evaluated for other co-existing anomalies. Percentile charts provided in the present study may also be applicable across India but more studies are required to validate the authors' contention.

Interdistrict variations in child health status and health services utilization: lessons for health sector priority setting and planning from a cross-sectional survey in rural India

BACKGROUND

There are limited data on interdistrict variations in child health status and health services utilization within the states of India. We conducted this study to identify and understand district-wise variations in child morbidity, mortality, healthcare seeking, and the status of health facilities in India.

METHODS

A cross-sectional population-based cluster survey was conducted from April to July 2007 in 16 districts of eight states in India. Two districts with similar demographic profile and health criteria were selected from each study state.

RESULTS

A total of 216 794 households and 24 812 under-5 children were surveyed. There were wide interdistrict variations in the health status of children within the same state and between different states across India. Interdistrict difference of >5 points/1000 live-births was found for infant mortality rate and under-5 mortality rate in all eight study states, while in six out of eight states this difference was >10 points/1000 live-births. Four states had a difference of >10 points/1000 live-births between respective districts for neonatal mortality rate. The interdistrict differences were also noted in childhood morbidity and health-seeking behaviour. Analysis of proportion of health facilities conforming to Indian public health standards revealed that the difference was m10% for availability of vaccines in five states, emergency services in three, laboratory services and logistics in four each, and referral facility in three of the eight study states.

CONCLUSION

This study underscores an important information gap in the country where planners seem to rely heavily on a few selected national-level databases that may not be adequate at the micro level. The current process of sporadic health surveys also appears inadequate and inappropriate. There is a need for district-specific data for planning, improving quality of service and generating demand for health service utilization to improve child survival in India. The findings of this study may prove useful for child health programme planning in India.

Molecular characterization of drug-resistant and drug-sensitive Aspergillus isolates causing infectious keratitis

PURPOSE

To study the susceptibilities of Aspergillus species against amphotericin B in infectious keratitis and to find out if drug resistance had any association with the molecular characteristics of the fungi.

MATERIALS AND METHODS

One hundred and sixty Aspergillus isolates from the corneal scrapings of patients with keratitis were tested for susceptibilities to amphotericin B by broth microdilution method. These included Aspergillus flavus (64 isolates), A. fumigatus (43) and A. niger (53). Fungal DNA was extracted by glass bead vertexing technique. Polymerase chain reaction (PCR) assay was standardized and used to amplify the 28S rRNA gene. Single-stranded conformational polymorphism (SSCP) of the PCR product was performed by the standard protocol.

RESULTS

Of the 160 isolates, 84 (52.5%) showed low minimum inhibitory concentration (MIC) values (≤ 1.56 μg/ml) and were designated as amphotercin B-sensitive. Similarly, 76 (47.5%) had high MICs (≥ 3.12 μg/ml) and were categorized as amphotericin B-resistant. MIC 50 and MIC 90 values ranged between 3.12-6.25 μg/ml and 3.12-12.5 μg/ml respectively. A. flavus and A. niger showed higher MIC 50 and MIC 90 values than A. fumigatus. The SSCP pattern exhibited three extra bands (150 bp, 200 bp and 250 bp each) in addition to the 260 bp amplicon. Strains (lanes 1 and 7) lacking the 150 bp band showed low MIC values (≤ 1.56 μg/ml).

CONCLUSION

A. niger and A. flavus isolates had higher MICs compared to A. fumigatus, suggesting a high index of suspicion for amphotericin B resistance. PCR-SSCP was a good molecular tool to characterize Aspergillus phenotypes in fungal keratitis.

Zinc deficiency amongst adolescents in Delhi

A cross sectional study was conducted in 260 adolescent schoolchildren (114 males) in the age group of 11-18 years to estimate the prevalence of zinc deficiency in the National Capital Territory of Delhi. Serum zinc was estimated using Inductively coupled plasma mass spectrometer. Overall, 49.4% children (50.8% males, 48.2% females) were found to have a deficient zinc nutriture.

High prevalence and low awareness, treatment and control of hypertension in Asian Indian women

Hypertension is an important public health problem in India. To determine its prevalence, awareness, treatment and control among women, we performed a nationwide study. Population-based studies among women aged 35-70 years were performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4608 (rural 2604 and urban 2004) of the targeted 8000 (57%). Demographic details, medical history, diet, physical activity, anthropometry and blood pressure (BP) were recorded. Descriptive statistics are reported. Logistic regression was performed to determine the association of hypertension and its awareness, treatment and control with socioeconomic factors. Age-adjusted prevalence of hypertension (known or BP≥140/≥90 mm Hg) was observed in 1672 women (39.2%) (rural 746, 31.5%; urban 926, 48.2%). Significant determinants of hypertension were urban location, greater literacy, high dietary fat, low fibre intake, obesity and truncal obesity (P<0.01). Hypertension awareness was noted in 727 women (42.8%), more in urban (529, 56.8%) than in rural (198, 24.6%). Of these, 38.6% of the women were on treatment (urban 35.7, rural 46.5) and of those treated, controlled blood pressure (<140 and <90 mm Hg) was observed in 21.5% (urban 28.3 vs 10.2). Among hypertensive subjects, treatment was noted in 18.3% (rural 13.1, urban 22.5) and control in 3.9% (rural 1.3, urban 5.9). A significant determinant of low awareness, treatment and control was rural location (multivariate-adjusted P<0.05). There is a high prevalence of hypertension in middle-aged Asian Indian women. Very low awareness, treatment and control status are observed.

Cholesterol ester transfer protein and apolipoprotein E gene polymorphisms in hyperlipidemic Asian Indians in North India

We determined the distribution of the polymorphic variants of CETP TaqIB and ApoE genes and their association with lipid and anthropometric parameters in hyperlipidemic and normolipidemic Asian Indians in North India. CETP TaqIB and ApoE polymorphism were assayed by PCR-RFLP in hyperlipidemic (n = 220) and normolipidemic (n = 367) subjects. Plasma lipids levels were estimated using commercially available kits from Randox (USA). The distribution of CETP TaqIB genotypes and alleles did not differ between the two groups. The frequency of ApoE ε4 allele was significantly higher in hyperlipidemic than normolipidemic subjects. Serum lipid levels were comparable between subjects with the different CETP TaqIB and ApoE genotypes in the two groups. Multivariate analysis after adjusting for age, sex, BMI, WHR, and total skinfold thickness showed that subjects with the Ε3Ε4 genotype and ε4 allele carriers were at significantly higher odds to develop hyperlipidemia [2.07 (1.29-3.30) and 2.05 (1.30-3.24), respectively] as compared to the other genotypes. ApoE ε4 allele and E3E4 genotype emerged as important genetic markers for hyperlipidemia in this study population.

Aetiology of global developmental delay in young children: experience from a tertiary care centre in India

BACKGROUND

Global developmental delay is a common reason for referral to a paediatrician. We examined the aetiological yield of an extensive diagnostic work-up in young children with developmental delay in a tertiary referral centre.

METHODS

To assess the diagnostic possibilities, we systematically examined 100 consecutive children with global developmental delay (< 5 years of age) who visited the paediatric outpatient department over a period of 18 months. An association between the presence of features at initial contact and aetiology was analysed by the 2-tailed Fisher exact test and chi-square test.

RESULTS

Of the 100 children, 65 were < 2 years of age (mean age 23.6 months) at presentation. The presence of birth asphyxia, sepsis, seizures, abnormal neurological findings, and dysmorphism were significant predictors of aetiology. Four diagnostic categories--chromosomal disorders including Down syndrome, hypoxic-ischaemic encephalopathy, multiple malformation syndromes and cerebral dysgenesis--were the most common causes of global development delay in 20%, 15%, 14% and 11%, respectively. Moderate delay was seen in 42%, severe in 33% and mild in 25% of the patients. The aetiological yield did not differ with the severity of global developmental delay. Additional investigations such as neuroimaging, cytogenetic analysis, metabolic tests and specific molecular tests contributed to a diagnosis in 73% of the children, while in 23% these were the sole means of arriving at a diagnosis. Neuroimaging for a specific indication was almost twice more likely to yield an aetiology when compared with neuroimaging performed as a screening tool (65% v. 35%; p = 0.003).

CONCLUSION

The aetiological yield in this selected cohort with global developmental delay was 73%. A step-wise investigational approach is justified in all children with developmental delay, regardless of the severity of delay or the absence of findings on history and physical examination. This study is an attempt to formulate an investigative approach in a child with global developmental delay, especially in developing countries where advanced molecular and cytogenetic studies are not routinely available.

Correlation of proteinase production with amphotericin B resistance in fungi from mycotic keratitis

Two hundred fungal isolates (Aspergillus and Fusarium species) from mycotic keratitis were tested for in vitro susceptibilities to amphotericin B and proteinase production. Geometric mean MICs for all fungal species increased fourfold with thousandfold increase in the inoculum. The MIC(50) and MIC(90) values ranged between 3.12-6.25 and 3.12-12.5 microg/ml, respectively. Proteinase production was noted in 113 (56.5%) isolates. Ninety-eight (49%) showed MICs of > or =1.56 microg/ml that was above the criteria of > or =1 microg/ml for amphotericin B resistance (CLSI). Seventy-three (74.5%) of these 98 isolates were proteinase producers, whereas only 40 (39.2%) of the remaining 102 with low MICs (<1.56 microg/ml) were proteinase producers (p < 0.001). Proteinase seems to be an important virulence marker of filamentous fungi in mycotic keratitis, correlating significantly with amphotericin B resistance.

Topical mitomycin C as a postoperative adjunct to endonasal dacryocystorhinostomy in patients with anatomical endonasal variants

PURPOSE

Unusual intranasal conditions may increase the rate of complications and affect success rate of endonasal dacryocystorhinostomy (DCR) surgery. The purpose of this study was to find the influence of endonasal abnormalities on outcome of endonasal DCR surgery and to find the role of topical mitomycin C (MMC) as a postoperative adjunct to endonasal dacryocystorhinostomy in these patients.

METHODS

A total of 23 patients (19 males and 4 females) of bilateral chronic dacryocystitis in the age range of 18-60 years, having endonasal anatomical variants were included in this study. After endonasal DCR, the right side of nasal cavity was packed with 0.05% MMC nasal pack and left side of nasal cavity was packed with normal saline pack for 48 hours. During postoperative visits, the patients were checked for improvement in clinical symptoms and watched for complications including formation of adhesions and/or synechaie. The statistical association between endonasal pathologies and 3 dichotomous outcome variables (clinical features, adhesions, synechaie) was assessed by applying Fisher's Exact Test.

RESULTS

Postoperative retention of nasal packs for 48 hours after endonasal DCR, did not cause any side effect in our patients. An improvement in clinical symptoms (23/23 = 100%) was seen in all the patients on side with 0.05% MMC soaked nasal pack, while 10/23 i.e., 43.47% patients did not show improvement in symptoms on side of saline nasal pack. Postoperatively, the MMC nasal pack side nasal cavity had a healthy nasal mucosa during the entire follow up, while the saline nasal pack side nasal cavity had synechiae in 15/23 (65.2%) patients and adhesions in 15/23 (65.2%) patients. In our study, none of the anatomical endonasal variants had a statistically significant association with either formation of adhesion or formation of synechiae, as the p-value was > 0.05 in all these instances.

CONCLUSIONS

The patients with endonasal anatomical variants have a higher incidence of complications like formation of adhesions and synechaie after endonasal DCR than other patients. Topical MMC is safe and effective agent to decrease the rate of complications when used as an adjunct in endonasal DCR in patients with endonasal anatomical variants.

Atherosclerosis in Asian Indians with systemic lupus erythematosus

OBJECTIVES

Atherosclerosis has emerged as an important late complication of systemic lupus erythematosus (SLE). Asian Indians, as an ethnic group, are known to be metabolically predisposed to development of early atherosclerosis. No data on this aspect of SLE are available from Asia. This study was undertaken to find the frequency of atherosclerosis in Indian lupus patients and the factors affecting such an occurrence.

METHODS

Carotid artery intimo-medial thickness (IMT) and plaque were used as markers of atherosclerosis. High-resolution B-mode ultrasonography was used to compare carotid IMT and plaque in 50 patients with SLE and 50 age- and sex-matched healthy controls.

RESULTS

Patients with lupus (age 31.6+/-10.05, median 30.5 years; disease duration 52.3+/-36.7, median 46 months) exhibited a significantly greater IMT than controls (0.417+/-0.07 vs. 0.362+/-00.07 mm; p = 0.003). Carotid plaques were seen in seven (14%) cases. None of the control population had plaques (p = 0.006). On bivariate analysis, the IMT was significantly affected by age, systolic blood pressure (SBP), disease duration and menopausal status. On multivariate analysis, the only factor significantly affecting IMT was SBP. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) score was the sole factor found to significantly affect the occurrence of plaque.

CONCLUSIONS

Asian Indian lupus patients in our study, despite being relatively young and with shorter disease duration, exhibited premature atherosclerosis in the form of significantly thicker intimo-media and plaque. The factors found to affect accelerated atherosclerosis in our cohort were age, SBP, disease duration, postmenopausal status and the SLICC/ACR score.

Behavioral risk factors for non-communicable disease among factory employees in Faridabad; Haryana

INTRODUCTION

In developing countries like India, in addition to the infectious diseases, non-communicable diseases are emerging as significant causes of morbidity and mortality. Workplaces present a setting which is appropriate for intervention for adults in a community. The aim of this study is to assess the knowledge, attitude and prevalence of selected risk factors for non-communicable diseases.

METHODS

A cross sectional study was conducted among the regular employees of the factories. Smoking, alcohol consumption, dietary intake and physical activity were measured through interview schedules and height, weight and blood pressure were also measured by standard instrument. An awareness generation program was pre-tested.

RESULTS

A total of 545 employees were interviewed. Among them 307 (56.3%) and 238 (43.7%) were manual and non-manual workers respectively. Most of the employees knew [smoking as a risk factor for hypertension (55.2%), heart attack (61.1%) and cancer (78.7%); Alcohol as a risk factor for hypertension (72.1%), heart attack (73.9%), cancer ( 54.9%); Physical inactivity as a risk factor for hypertension (82.6%), heart attack (78.5%), diabetes (60.4%) and high fat diet as a risk factor for hypertension (67.2%), heart attack (64.8%)] that these risk factors lead to different non-communicable diseases. The prevalence (95% CI) of the risk factors is as follows: male current smoker [40.7% (36.4-45.3)], current alcohol consumption [31.0 % (27.2 - 35.1)], sedentary activity [41.2% (37.0 - 45.5)], high fat intake [93.7% (90.2 - 95.5)], over weight [26.9% (23.2 - 30.9)]; and hypertension [21.0% (17.62 - 24.6)]

CONCLUSIONS

This study showed that the risk factors for non-communicable diseases are prevalent in factory employees. Implementation of the risk factors control programme is desirable and there is an interest among employees and management.

Obstructive sleep apnoea correlates with C-reactive protein in obese Asian Indians

BACKGROUND

C-reactive protein (CRP), a marker of systemic inflammation, is an important predictor of future cardiovascular events. Whether the relationship of obstructive sleep apnoea (OSA) and CRP is independent of adiposity, needs to be investigated.

OBJECTIVE

To investigate the association of CRP levels with OSA in the obese and their comparison with lean subjects without OSA in Asian Indians residing in India.

METHODS AND RESULTS

One hundred and eight obese subjects (62 treatment naïve obese subjects with OSA [cases] and 46 obese subjects without OSA [obese controls]) and 26 lean control subjects without OSA were studied. The subjects were without any apparent inflammatory disease. Obese subjects were matched for body mass index (BMI) and percentage body fat (%BF). Assessment included anthropometry, lipid profile and high sensitivity CRP (hs-CRP) levels. Mean hs-CRP levels were significantly higher in cases [(3.6+/-2.0) mg/l than in obese controls (1.4+/-1.4) mg/l, p<0.001)] and in lean controls [(0.93+/-0.71) mg/l, p>0.05].

CONCLUSIONS

In this sample of Asian Indians, subjects with OSA had significantly higher CRP levels. These levels were directly proportional to the increase in severity of OSA and it was independent of adiposity. These observations have important implications for future cardiovascular risk in Asian Indians with OSA.

A case-control study on insulin resistance, metabolic co-variates & prediction score in non-alcoholic fatty liver disease

BACKGROUND & OBJECTIVE

Asian Indians have a high prevalence of insulin resistance and the metabolic syndrome. Currently, non-alcoholic fatty liver disease (NAFLD) is considered to be an integral part of the metabolic syndrome with insulin resistance as a central pathogenic factor. We studied anthropometric parameters, insulin resistance and metabolic co-variates in subjects with NAFLD as compared to those without NAFLD, and also developed a prediction score for NAFLD.

METHODS

Thirty nine subjects with NAFLD and 82 controls were selected for the study after ultrasonography of 121 consecutive apparently healthy subjects. Anthropometric profile [body mass index (BMI), waist circumference (WC) etc,], lipid profile, hepatic aminotransferases, fasting blood glucose (FBG), insulin were recorded and value of homeostasis model assessment of insulin resistance (HOMA-IR) was analysed. Step-wise logistic regression analysis and area under the receiver operator curve (aROC) were analysed to arrive at a prediction score.

RESULTS

Overall, prevalence of NAFLD was 32.2 per cent and prevalence of metabolic syndrome was seen in 41 per cent among cases and 19.5 per cent in controls (P<0.01). Subjects with NAFLD had significantly higher values of BMI, WC, hip circumference, FBG, fasting insulin, total cholesterol and serum triglycerides. Step-wise logistic regression analysis showed odds ratio (OR) and 95 per cent confidence interval (CI) for BMI [ 4.3 (1.6, 11.3)], FBG [5.5 (1.5, 19.8)] and fasting insulin [ 2.4 (1.0, 5.8)] as independent predictors of NAFLD. The prediction score for NAFLD was; 1 (fasting insulin) +1.6 (BMI) + 1.9 (FBG) (sensitivity of 84.6%, specificity of 51.2% and aROC 76%).

INTERPRETATION & CONCLUSION

In this study, presence of NAFLD indicated close relationship with multiple features of metabolic syndrome. The prediction score developed could be used as a screening tool to predict NAFLD among Asian Indians in north India.

Role of acute viral hepatitis as a confounding factor in antituberculosis treatment induced hepatotoxicity

BACKGROUND & OBJECTIVE

Drug induced hepatotoxicity (DIH) is an important and commonly encountered adverse effect with antituberculosis (anti-TB) treatment. Acute viral hepatitis (AVH) is an important confounding reason which clinically, biochemically and histologically mimics DIH.

METHODS

The contributory role of acute viral hepatitis as a confounding factor in patients with normal baseline liver functions who developed acute hepatitis while receiving short-course anti-TB treatment was prospectively studied. The sera of all patients who developed acute hepatitis were analysed for markers for hepatitis A, B, C and E viruses.

RESULTS

Viral hepatitis was present in 15 of the 102 (14.7%) patients who developed acute hepatitis while receiving anti-TB treatment with hepatitis E virus being the most common cause Later onset of acute hepatitis [58 (5-133) vs. 26 (3-221) days; P=0.04], large elevations in aspartate aminotransferase (AST) [371 (30-2643) vs. 212 (63-1990 IU/l); P=0.03] and alanine aminotransferase (ALT) [388 (31-2997) vs. 225 (52- 1670 IU/l); P= 0.002] and a longer time for normalization of deranged liver functions [36.7 +/- 13.3 vs. 24.5 +/- 19.3 days; P=0.02] indicated acute viral hepatitis as the cause of liver function derangement.

INTERPRETATION & CONCLUSION

Our findings showed AVH in 14.7 per cent patients who developed hepatotoxicity while an anti-TB treatment. Therefore, in endemic areas, viral hepatitis should be sought after and excluded in all patients suspected to have DIH before attributing the hepatotoxic effect to the anti-TB drugs.

Distribution and cutoff points of fasting insulin in Asian Indian adolescents and their association with metabolic syndrome

AIM

To evaluate the levels and appropriate cutoff points of fasting insulin, and their association with the metabolic syndrome (MS) in Asian Indian adolescents.

METHODS

This cross-sectional, population based study included 948 (527 males & 421 females) adolescent subjects aged 14-19 years selected randomly from New Delhi, India. Cutoff points of fasting insulin were defined using Receiver Operating Characteristics curve analysis against overweight, abdominal obesity and high subscapular skinfold thickness. The MS was defined according to NCEP, ATP III and IDF criteria using age-, gender- and ethnicity-specific cutoff points.

RESULTS

Fasting insulin levels peaked at 16 y and reduced subsequently in both genders. The derived cutoff points for fasting insulin (pmol/L) were: 14-15 y- 128.5 and 164.8; 16-17 y- 126.1 and 152.8; 18-19 y- 121.2 and 162.4 in males and females, respectively. Prevalence of fasting hyperinsulinemia (39.1%) and MS (NCEP 2.2%, IDF 1.5%) was highest in age group 16-17 years.

CONCLUSION

The data from this first study describing the distribution and cutoff points of fasting insulin in Asian Indian adolescents may be helpful for detection of and application of primary prevention strategies for fasting hyperinsulinemia and the metabolic syndrome in this population.