Traumatic brachial plexus injury: electrodiagnostic findings from 111 patients in a tertiary care hospital in India

OBJECTIVE

The study aims to characterise the electrodiagnostic findings of patients with traumatic brachial plexus injuries (BPIs) in India and to analyse the association between aetiologies and levels of injuries.

METHODS

A total of 111 consecutive electrodiagnostic studies done between January 2009 and June 2011 on persons with traumatic BPI were retrospectively analysed.

SETTING

Electrodiagnostic Laboratory, Department of Physical Medicine and Rehabilitation in a tertiary care university teaching hospital in South India.

MAIN OUTCOME MEASURES

Nerve conduction velocities and electromyography (EMG) to locate the level of BPI, Dumitru and Wilbourne scale to assess the severity of BPI.

RESULTS

We studied 106 males and five females, ranging from 11 to 59 years of age. All but one had unilateral BPI. Motorcycle crashes were the most frequent cause (n=64, 58%). Isolated supraclavicular injury was found in 98 arms (88%) and infraclavicular injury in seven arms (6%). Root-level injuries were more common in motorcycle crashes and occupation-related trauma, while trunk-level injuries were more often found in automobile crashes, falls, bicycle-related trauma and penetrating wounds. Pan root (C5-T1) involvement was more common in the motorcycle trauma group (74%). There was no significant association between aetiologies and levels of BPIs. A total of 73 (65%) plexus injuries were of 'severe' category as per Dumitru and Wilbourn scale.

CONCLUSIONS

Motorcycle crash is the most common cause of traumatic BPIs. Supraclavicular injury is the rule in most cases. Proper attention needs to be given to differentiate the mild to moderate injuries from the severe injuries with EMG techniques since most of the cases are severe. There was no significant association found between aetiologies and levels of injury.

Function after total calcanectomy for malignant tumor in a child: is complex reconstruction necessary?

Complex reconstruction after calcaneal excision for aggressive or malignant tumors has been advocated. In this report we describe a 7-year-old child who underwent chemotherapy followed by total calcanectomy for a primitive neuroectodermal tumor of the calcaneum. The near-normal function achieved after the operation leads us to believe that complex reconstruction after calcaneal excision is not warranted in every pediatric case. This report also highlights the benefits of the Cincinnati incision for calcanectomy, and describes the gait abnormalities after the operation. To the best of our knowledge, a description of the gait abnormality observed after calcanectomy for tumor resection in a pediatric patient has not been reported up to now.

A patient-prioritized ability assessment in haemophilia: the Canadian Occupational Performance Measure

Assessment of musculoskeletal function in individuals with haemophilia has been attempted with clinimetric instruments, which use predetermined domains for assessing the same. This study introduces the application of an instrument, the Canadian Occupational Performance Measure (COPM), which is an open-ended questionnaire that allows patients to prioritize their needs and rate their performance in different tasks of daily living as well as their satisfaction in performing them. To study the utility of COPM in evaluating the musculoskeletal functional status of patients with haemophilia and to assess its effectiveness in planning individualized management plans for them. COPM was administered to 67 individuals with haemophilia aged 10-55 years and the data were compared with functional deficits identified through FISH (Functional Independence Score for Haemophilia). A total of 31 performance difficulties in the areas of self-care (62%), productivity (21%) and leisure (17%) were identified by COPM. All eight domains of FISH were identified in COPM as problems in self-care. In addition to these, COPM identified problems in the areas of productivity and leisure. In 78% of the responses on COPM, there was concordance between the performance and satisfaction scores. However, there was discordance between the two in the remaining 22% of responses. COPM is a useful tool for assessment of musculoskeletal dysfunction in haemophilia. It provides a greater insight into the needs of each patient and helps in planning individualized intervention strategies.

Management of patients with fibromyalgia using biofeedback: a randomized control trial

OBJECTIVE

Fibromyalgia syndrome (FMS) is a chronic rheumatological condition which could be characterized by generalized pain and fatigue. Cognitive and behavioral therapy has been found to be a suitable technique in the management of FMS. This study intends to evaluate the efficacy of electromyography (EMG) biofeedback to reduce pain in patients with FMS.

MATERIALS AND METHODS

A randomized controlled trial involving two groups of FMS patients, one receiving EMG biofeedback and the other a sham biofeedback, was carried out. The assessment tools included in the study were fibromyalgia impact questionnaire (FIQ), visual analogue scale (VAS), six-minute walk test (SMWT) and number of tender points; and tenderness of each tender point was done for both the groups.

STATISTICS

A Student's 't' test was used to study the test for significance.

RESULTS

After using biofeedback, the mean VAS scores and the mean number of tender points were found to be 3 out of 10 and 6 out of 18 respectively. Subjective analysis from both groups showed improvement in physical and psychological realms. Statistical significance.

CONCLUSION

Biofeedback as a treatment modality reduces pain in patients with FMS, along with improvements in FIQ, SMWT and the number of tender points.

Podophyllum hexandrum modulates gamma radiation-induced immunosuppression in Balb/c mice: Implications in radioprotection

Aqueous extract of Podophyllum hexandrum (RP-1), which has been reported to render more than 82% survival against whole body lethal (10 Gy) gamma-irradiation in mice, was further investigated for its immunomodulatory potential. In this study, no significant change could be scored in peritoneal macrophages survival up to 8th day after whole body irradiation. RP-1 treatment (200 mg/kg body weight, i.p.) alone or 2 h before whole body irradiation enhanced macrophage survival significantly (p<0.05) as compared to irradiated control mice. In irradiated animals, there was significant (p<0.01) reduction in splenocyte survival and proliferation as revealed by 3H-TdR method. RP-1 treatment (200 mg/kg) alone or 2 h before irradiation countered the decrease in survival of splenocytes and proliferation significantly (p<0.05) as compared to irradiated control group. Whole body irradiation also significantly (p<0.05) reduced the population of CD4+ and CD8+ T cells and bone marrow GM-CFU at 24 h and 72 h post-irradiation intervals, respectively, as compared to unirradiated control. RP-1 treatment 2 h before whole body irradiation countered the decrease in CD4+ and CD8+ T cells populations and CGM-CFU. Nitric oxide free radicals generation was enhanced significantly (p<0.05) in the supernatant of peritoneal macrophage cultures exposed to 2 Gy gamma radiation ex vivo in comparison to unirradiated control, which was reduced by pre-irradiation (-2 h) administration of RP-1. Whole body irradiation (10 Gy) also reduced the serum titres of IL-3, IL-1 and various IgG isotypes observed at different post-irradiation time interval. RP-1 treatment alone or before whole body irradiation countered radiation induced decrease in the titre of IL-1, IL-3 and IgG's in the serum of mice. These findings indicate immunostimulatory potential of RP-1.

Modification of gamma radiation induced response of peritoneal macrophages and splenocytes by Hippophae rhamnoides (RH-3) in mice

Alcoholic extract of Hippophae rhamnoides, RH-3, reported to render >80% survival against lethal whole body Co-60-gamma irradiation (10 Gy) in mice, was investigated for its immunostimulatory effects. In comparison with un-irradiated control, whole body irradiation did not reduce peritoneal macrophage counts at 24 h post-irradiation. RH-3 treatment (30 mg kg(-1) body weight) alone or 30 min before whole-body irradiation enhanced viable counts of macrophages significantly (P< or =0.05) compared with both un-irradiated control and irradiated groups. Whole-body irradiation reduced the number of viable splenocytes significantly (P<0.05) compared with un-irradiated control at 24 h post-irradiation. RH-3 treatment alone or before whole-body irradiation appreciably countered radiation-induced decrease in splenocyte count. 3H-thymidine uptake method revealed that whole-body irradiation reduced splenocyte proliferation significantly (159 +/- 45 counts min(-1)/10(6) cells; P< or =0.05) in comparison with control (607 +/- 142 counts min(-1)) at 24 h after irradiation but RH3 treatment before irradiation reduced the steep decrease and maintained it as 444+/-153 counts min(-1). After whole-body irradiation, the ratio of spleen weight/mouse weight decreased to 1.5 +/- 04 compared with 2.9 +/- 0.32 in un-irradiated control at 24 h post-irradiation. Similarly, total protein content in splenocytes also decreased to 48 +/- 6 microg/10(6) cells in comparison with 368 +/- 16 microg/10(6) cells of un-irradiated control. RH-3 treatment before irradiation countered radiation-induced decrease in both spleen weight/mouse weight ratio (4.0 +/- 0.35) and total protein content (360 +/- 13 mug/10(6) splenocytes). In the supernatant of peritoneal macrophage cultures exposed to 2 Gy Co-60-gamma radiation ex-vivo, the total nitrite content was enhanced significantly (P<0.05) to 5.72 +/- 0.09 microM in comparison with un-irradiated control (1.64 +/- 0.09 microM). RH-3 treatment (30 microg mL(-1)) before irradiation reduced total nitrite significantly (0.93 +/- 0.3; P< or =0.05) in comparison with irradiated control group. At 24 h after whole body irradiation, the CD4+/CD8+ ratio reduced to 1.5 in comparison with un-irradiated control (1.9) but RH-3 treatment before irradiation restored the ratio to 2.1. These findings explicitly reveal the immunostimulatory activity of RH-3, which may play an important role in the manifestation of its radioprotective efficacy.

Serial epidemiological surveys in an urban Indian population demonstrate increasing coronary risk factors among the lower socioeconomic strata

OBJECTIVE

To determine trends of coronary risk factors in an Indian urban population and their association with educational level as marker of socioeconomic status.

METHODS

Two successive coronary risk factor surveys were performed in randomly selected individuals. In the first study (in 1995) 2212 subjects (1415 men, 797 women) and in the second (in 2002) 1123 subjects (550 men, 573 women) were studied. Details of smoking, physical activity, hypertension, diabetes, coronary heart disease, body-mass index, waist-hip ratio, blood pressure and electrocardiography were evaluated. Fasting blood was examined for lipid levels in 297 (199 men, 98 women) in the first and in 1082 (532 men, 550 women) in the second study. Educational status was classified into Group 0: no formal education, Group I: 1-10 years, Group II: 11-15 years, and Group III: > 16 years. Current definitions were used for risk factors in both the studies.

RESULTS

Prevalence of coronary risk factors, adjusted for age and educational status, in the first and second study in men was smoking/tobacco in 38.7 vs. 40.5%, leisure time physical inactivity in 70.8 vs. 66.1%, hypertension (> or = 140 and/or 90 mm Hg) in 29.5 vs. 33.7%, diabetes history in 1.1 vs. 7.8%, obesity (body-mass index > or = 25 Kg/m2) in 20.7 vs. 33.0%, and truncal obesity (waist:hip > 0.9) in 54.7 vs. 54.4%. In women, tobacco use was in 18.7 vs. 20.5%, leisure time physical inactivity in 72.4 vs. 75.3%, hypertension in 36.9 vs. 33.7%, diabetes history in 1.0 vs. 7.3%, obesity in 19.9 vs. 39.4%, and truncal obesity (waist:hip > 0.8) in 70.1 vs. 69.2%. In men, high total cholesterol > or = 200 mg/dl was in 24.6 vs. 37.4%, high LDL cholesterol > or = 130 mg/dl in 22.1 vs. 37.0%, high triglycerides > or = 150 mg/dl in 26.6 vs. 30.6% and low HDL cholesterol < 40 mg/dl in 43.2 vs. 54.9%; while in women these were in 22.5 vs. 43.1%, 28.6 vs. 45.1%, 28.6 vs. 28.7% and 45.9 vs. 54.2% respectively. In the second study there was a significant increase in diabetes, obesity, hypertension (men), total- and LDL cholesterol and triglycerides and decrease in HDL cholesterol (p < 0.05). In the first study with increasing educational status a significant increase of obesity, total cholesterol, LDL cholesterol and triglycerides and decrease in smoking was observed. In the second study increasing education was associated with decrease in smoking, leisure-time physical inactivity, total and LDL cholesterol, and triglycerides and increase in obesity, truncal obesity and hypertension (Least-squares regression p < 0.05). Increase in smoking, diabetes and dyslipidaemias was greater in the less educated groups.

CONCLUSIONS

Significant increase in coronary risk factors--obesity, diabetes, total-, LDL-, and low HDL cholesterol, and triglycerides is seen in this urban Indian population over a seven year period. Smoking, diabetes and dyslipidaemias increased more in low educational status groups.

Protection of jejunal crypts by RH-3 (a preparation of Hippophae rhamnoides) against lethal whole body gamma irradiation

RH-3, an alcoholic extract of whole berries of Hippopheae rhamnoides, has been demonstrated to provide radioprotective activity in terms of survival of mice against whole body lethal irradiation (10 Gy). It was, therefore, investigated for its mode of action by monitoring crypt survival, cellularity of crypts and villi and the magnitude of apoptosis in the GI tract. Administration of RH-3 before irradiation (-30 min) increased the number of surviving crypts in the jejunum by a factor of 2.02 (p < 0.05) and villi cellularity by 2.5 fold (p < 0.05) in comparison to the irradiated control. RH-3 administration before irradiation also reduced the incidence of apoptotic bodies in the crypts (p < 0.05) in a time dependent manner and increased cellularity in the crypts and villi (84 h post irradiation) as compared to control. Caspase-3 activity was also significantly lower in the mice administered RH-3 before irradiation as compared to irradiated control. This study indicates that reduction in the radiation induced loss of cellularity of crypts and villi and also decrease in frequency of apoptosis could have contributed towards protection of mice treated with RH-3 before irradiation. The cellular and molecular mechanisms of radioprotection by Rh-3 need to be investigated further in detail.

Hindu-Muslim differences in the prevalence of coronary heart disease and risk factors

Differences in coronary risk factors and coronary heart disease (CHD) prevalence between the Hindus and the Muslims have not been adequately studied. This study aims to determine the prevalence of certain socio-economic and biological coronary risk factors in urban communities and to compare the findings found in the Hindus and the Muslims. The study employed a cross-sectional survey design and stratified random sampling technique consisting of 1,415 males and 797 females. Among males there were 1,092 Hindus (77.2%) and 272 Muslims (19.2%) while in females there were 685 Hindus (85.9%) and 91 Muslims (11.4%). Prevalence of illiteracy and sedentary lifestyle were significantly more in Muslims (p<0.05). Smoking or tobacco use in males was similar but in females it was more in the Hindus. Self-reported diabetes was found in 1.4% Hindu males and in 1.2% Hindu females. No Muslim reported diabetes. Hindu males were significantly taller than Muslims (163.9 +/- 8.3 versus 160.9 +/- 8.9 cm; p < 0.001). In both males and females there was no significant difference in body mass index and obesity. In Hindu males the diastolic BP was significantly greater than in Muslims (81.2 +/- 9.2 versus 79.0 +/- 8.6 mm Hg; p < 0.001); prevalence of hypertension (30.5% versus 25.7%) was also significantly more (p = 0.048). In Hindu females the mean systolic BP was significantly more and there was also difference in hypertension prevalence (35.2% versus 25.3%). CHD prevalence was significantly greater in Hindu males as compared to the Muslims when determined by the presence of either ECG changes alone (4.3% versus 0.7%; p = 0.008) or ECG changes combined with clinical history (7.1% versus 1.8%; p = 0.002). A similar, though not significant, trend was seen in females (ECG changes: 8.9% versus 6.6%, clinical and ECG changes: 10.4% versus 6.6%). The prevalence of CHD is significantly more in Hindu males as compared to the Muslims and is associated with a greater prevalence of diabetes and hypertension.

Transmigrated mandibular permanent canine: a case report

A case of transmigration of mandibular canine is presented. The importance of anesthetizing the transmigrated tooth from the side of origin is highlighted.

Lipid abnormalities in coronary heart disease: a population-based case-control study

BACKGROUND

We performed a case-control study to estimate lipid-cholesterol fractions in patients with coronary heart disease and compared them with population-based controls.

METHODS AND RESULTS

A total of 635 newly diagnosed patients with coronary heart disease (518 males and 117 females) and 632 subjects (346 males and 286 females) obtained from an ongoing urban coronary heart disease risk factor epidemiological study were evaluated. Age-specific lipid values (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and total:high-density lipoprotein cholesterol ratio) were compared using the t-test. Age-adjusted prevalence of dyslipidemia as defined by the US National Cholesterol Education Program was compared using the Chi-square test. In all the age groups, and in both males and females, levels of total and low-density lipoprotein cholesterol were not significantly different. In males, the high-density lipoprotein cholesterol (mg/dl) was significantly lower in patients with coronary heart disease as compared to controls in the age groups 30-39 years (35.1+/-11 v. 43.7+/-9), 40-49 years (39.0+/-10 v. 47.1+/-8), 50-59 years (38.9+/-11 v. 43.8+/-9) and 60-69 years (38.6+/-11, v. 42.8+/-7) (p<0.05). In females, high-density lipoprotein cholesterol was less in the age groups 30-39 years (30.2+/-9 v. 40.7+/-9), 50-59 years (39.7+/-12 v. 44.7+/-8) and 60-69 years (35.6+/-11 v. 42.2+/-9). The level of triglycerides was significantly higher in male patients in the age groups 40-49 years (195.3+/-96 v. 152.8+/-78), 50-59 years (176.7+/-76 v. 162.9+/-97), 60-69 years (175.5+/-93 v. 148.1+/-65) and >70 years (159.8+/-62 v. 100.0+/-22); and in female patients in the age group 30-39 years (170.8+/-20 v. 149.9+/-9) (p<0.05). The total:high-density lipoprotein cholesterol ratio was significantly higher in all age groups in male as well as female patients with coronary heart disease (p<0.05).

CONCLUSIONS

An age-adjusted case-control comparison showed that the prevalence of hypertension, diabetes, high total cholesterol (> or =200 mg/dl) (males 48.8% v. 20.2%; females 59.8% v. 33.4%) and high low-density lipoprotein cholesterol (> or =130 mg/dl) (males 42.1% v. 15.0%; females 52.1% v. 31.0%) was significantly more in cases than in controls. The prevalence of low high-density lipoprotein cholesterol (<35 mg/dl) (males 39.6% v. 6.2%; females 39.3% iv 9.5%), high total:high-density lipoprotein ratio (> or = 5.0) and high triglycerides (> or =200 mg/ dl: males 39.6%, v. 10.2%; females 17.1% v. 11.9%) was also significantly higher in cases (p<0.05).

Cholesterol lipoproteins, triglycerides, rural-urban differences and prevalence of dyslipidaemia among males in Rajasthan

To develop profiles of serum cholesterol lipoproteins and triglycerides, influence of rural versus urban lifestyle in their levels and prevalence of dyslipidaemias, we studied cohorts of male population in Rajasthan. Fasting blood samples were obtained from 401 men (age range 20-73 years) randomly selected from a larger sample of 3397 during a comprehensive cardiovascular risk factor survey in rural (202 men) and urban (199 men) populations. Serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides (TG) were determined and correlated with age and anthropometric variables. The lipid levels were classified according to US National Cholesterol Education Program (NCEP) guidelines. The mean +/- SD levels in mg/dl were, total cholesterol 170.5 +/- 40, LDL cholesterol 102.1 +/- 36, HDL cholesterol 43.6 +/- 12 and TG 124.0 +/- 50. The mean levels in rural vs. urban population were total cholesterol 165 +/- 37 vs. 176 +/- 43 (p = 0.008), LDL cholesterol 97 +/- 33 vs. 108 +/- 39 (p = 0.003), HDL cholesterol 44 +/- 13 vs. 43 +/- 12 (p = 0.44) and TG 122 +/- 46 vs 126 +/- 55 (p = 0.41). There was significant positive correlation of age and body-mass index with total and LDL cholesterol and triglycerides but not with HDL cholesterol. When classified according to the NCEP guidelines high total cholesterol (> or = 240 mg/dl) and LDL cholesterol (> or = 160 mg/dl) was in 33 (8.3%). Borderline high total cholesterol (200-239) was in 64 (16%) and borderline high LDL cholesterol (130-159) in 55 (13.7%). Borderline high triglyceride (200-400 mg/dl) was in 33 (8.2%) and severe hypertriglyceridaemia in none. Low HDL cholesterol (< 35 mg/dl) was in 96 (23.9%) and protective level of HDL cholesterol (> or = 60 mg/dl) in 47 (11.7%). In urban as compared to rural men the prevalence of hypercholesterolaemia > 200 mg/dl (28% vs 22%) and hyper LDL cholesterolaemia (26% vs 18%) were significantly more.

Association of dietary ghee intake with coronary heart disease and risk factor prevalence in rural males

To determine the association between intake of dietary fat, specifically Indian ghee, and prevalence of coronary heart disease (CHD) and risk factors as study was undertaken on a rural population in Rajasthan. Total community cross-sectional survey was done using a physician administered questionnaire; 1982 males aged 20 years and more were studied. The dietary questionnaire focused on the amount and type of fat consumed. Staple dietary fat in this area is mustard/rapeseed oil and Indian ghee. To define the role of ghee, the average amount consumed in a month was determined; 782 males (39%) consumed 1 kg or more ghee per month (group 1) and 1200 (61%) consumed less than 1 kg per month (group 2). To elicit details of fatty acid composition of the diet consumed, detailed dietary history was acquired from a random 460 (23%) males; 220 from group 1 and 240 from group 2. Group 1 males were significantly younger, more literate and had more weight and body-mass index. This group consumed significantly more calories, saturated and mono-unsaturated fats while the consumption of polyunsaturated fats was similar in the two groups. Fatty acid intake analysis showed that group 1 males consumed more mono-unsaturated (n-9) fatty acids than group 2. Intake of polyunsaturated n-3 and n-6 fatty acids was similar. There was significantly lower prevalence of CHD in men who consumed > kg ghee per month (odds ratio = 0.23, 95% confidence limits 0.18-0.30, p < 0.001). Multivariate analysis confirmed this association (p < 0.001). The prevalence of hypertension and other coronary risk factors was similar in the two groups.

Prevalence and determinants of coronary heart disease in a rural population of India

BACKGROUND

The prevalence and determinants of coronary heart disease (CHD) have been inadequately studied in rural areas of developing countries.

METHODS

Entire communities were surveyed in randomly selected villages in Rajasthan, India. A physician-administered questionnaire, physical examination, and electrocardiogram (ECG) were performed on 3148 adults > or = 20 years of age (1982 males, 1166 females). Fasting blood samples for determination of lipids were obtained from 202 males and 98 females. Prevalence of coronary risk factors--smoking, hypertension, sedentary life-style, obesity, and hypercholesterolemia--was determined. CHD was diagnosed on basis of past documentation, response to WHO-Rose questionnaire, or changes in ECG. Three methods were used: (a) documentation, history, and ECG criteria, (b) ECG-Q, ST, or T changes, and (c) presence of Q waves.

RESULTS

Coronary risk factors: smoking was present in 51% males and 5% females, hypertension (> or = 140/90 mmHg) in 24% males and 17% females, hypercholesterolemia (> 200 mg/dl) in 22%, diabetes history in 0.2%, and irregular physical activity or sedentary habits in 85%. Other risk factors were lack of formal education in 44%, obesity (body-mass index > or = 27 kg/m2) in 6% and truncal obesity (waist-hip ratio > or = 0.95) in 5%. The prevalence of CHD (clinical + ECG criteria) was 3.4% in males and 3.7% in females. According to ECG criteria only, it was 2.8% in males and 3.3% in females and according to Q-waves only, it was 1.6% in males and 0.9% in females. Multivariate logistic regression analysis showed that age and smoking in males and age and systolic blood pressure in females were associated with higher prevalence of Q-wave CHD. In males, higher educational level and prayer habit were associated with lower prevalence.

CONCLUSIONS

Prevalence of CHD in this rural community is higher than in previously reported Indian studies. Smoking, hypertension, and sedentary lifestyle have high prevalence. Significant determinants of CHD are increasing age and smoking while education and prayer-habit are protective.

Prevalence and determinants of hypertension in the urban population of Jaipur in western India

OBJECTIVES

To determine age-specific blood pressure levels and prevalence of hypertension in an urban Indian population.

DESIGN AND SETTING

A cross-sectional survey in six randomly selected municipal blocks in Jaipur city, India.

SUBJECTS AND METHODS

There were 2122 subjects (1415 male, 797 female) aged 20 years or more. Evaluation was by physician-administered questionnaire, physical examination and electrocardiography. Diagnosis of hypertension used World Health Organization (WHO) and USA Fifth Joint National Committee (JNC-V) guidelines. Hypertension was subclassified according to the Framingham Study criteria.

RESULTS

The mean +/- SD blood pressures (mmHg) were 125 +/- 19 systolic and 81 +/- 24 diastolic in men and 126 +/- 20 systolic and 81 +/- 12 diastolic in women. A significant correlation of blood pressure with increasing age groups was seen. The prevalence of hypertension according to the JNC-V criteria was 30% in men and 33% in women; by WHO criteria it was 11% in men and 12% in women and increased with age in all subjects. In the JNC-V hypertensive group borderline isolated systolic hypertension was present in 13% of men and 17% of women, definite isolated systolic hypertension was present in 7% of men and 2% of women, isolated diastolic hypertension was present in 65% of men and 57% of women and definite hypertension was present in 16% of men and 24% of women. Multivariate analysis revealed that age, smoking and higher body mass index were independently associated with higher prevalence of hypertension both in men and in women.

CONCLUSIONS

A high prevalence of JNC-V-defined hypertension was found in an Indian urban population. Isolated diastolic hypertension was the commonest subtype. Significant determinants of hypertension were age, smoking and body mass index.

Prevalence of coronary heart disease and coronary risk factors in an urban population of Rajasthan

To determine the prevalence of coronary heart disease (CHD) and coronary risk factors in an urban Indian population, we studied a random sample of population of Jaipur. A physician-administered questionnaire, physical examination and a 12-lead electrocardiogram was performed on 2,212 adults of > or = 20 years of age (males 1,415, females 797). CHD was diagnosed on the basis of past documentation, response to WHO-Rose questionnaire or changes in the electrocardiogram. The overall prevalence of CHD was 7.6 percent (168 cases). The prevalence rate was 6.0 percent (84) in males and 10.4 percent (84) in females with an age-related increase in prevalence ('p' for trend < 0.001). When diagnosed on the basis of electrocardiographic changes alone (Q, ST or T wave), the prevalence was 5.2 percent (116), with 3.5 percent in males and 8.4 percent in females. CHD was silent in 57 percent males and 79 percent females. Coronary risk factors were observed in a significant proportion: smoking in 32 percent (males 39 percent, females 19 percent), hypertension (> or = 140/90 mm Hg) in 31 percent (males 30 percent, females 34 percent-JNC-V) and > or = 160/95 mm Hg in 11 percent (males 10 percent, females 12 percent; WHO classification), diabetes in 1 percent and sedentary habits in 71 percent. Additional risk factors were generalised obesity (body-mass index > or = 27 Kg/m2) in 11 percent and truncal obesity (waist-hip ratio > 0.95) in 17 percent males and 13 percent females. Significant association of CHD prevalence were seen with age, sedentary habits and presence of hypertension in both males and females, and in addition with smoking in males.

Multiple traumatic bone cysts of jaws. Report of a case

An unusual case of bilateral traumatic bone cyst occurring simultaneously in both jaws is being reported. The clinical features and treatment plan for these cysts have been discussed. It has been seen that exploration of such cystic cavity results in a rapid healing of the defect in a short span of time.

Skin grafting in severely contracted socket with the use of 'Compo'

The results of split thickness autologous skin grafting along with the use of a dental impression material (Compo), a thermoplastic substance are presented in a series of 11 patients of acquired, severely contracted, anophthalmic sockets. Only the fornix fixation sutures and the central tarsorrhaphy were employed for the proper placement of graft without the use of retention devices. Artificial eyes were successfully fitted and retained subsequently after 6 weeks of grafting.