Impact of Upper Limb Motor Recovery on Functional Independence After Traumatic Low Cervical Spinal Cord Injury

Cervical spinal cord injury (SCI) causes devastating loss of upper limb function and independence. Restoration of upper limb function can have a profound impact on independence and quality of life. In low-cervical SCI (level C5-C8), upper limb function can be restored via reinnervation strategies such as nerve transfer surgery. The translation of recovered upper limb motor function into functional independence in activities of daily living (ADLs), however, remains unknown in low cervical SCI (i.e., tetraplegia). The objective of this study was to evaluate the association of patterns in upper limb motor recovery with functional independence in ADLs. This will then inform prioritization of reinnervation strategies focused to maximize function in patients with tetraplegia. This retrospective study performed a secondary analysis of patients with low cervical (C5-C8) enrolled in the SCI Model Systems (SCIMS) database. Baseline neurological examinations and their association with functional independence in major ADLs-i.e., eating, bladder management, and transfers (bed/wheelchair/chair)-were evaluated. Motor functional recovery was defined as achieving motor strength, in modified research council (MRC) grade, of ≥ 3 /5 at one year from ≤ 2/5 at baseline. The association of motor function recovery with functional independence at one-year follow-up was compared in patients with recovered elbow flexion (C5), wrist extension (C6), elbow extension (C7), and finger flexion (C8). A multi-variable logistic regression analysis, adjusting for known factors influencing recovery after SCI, was performed to evaluate the impact of motor function at one year on a composite outcome of functional independence in major ADLs. Composite outcome was defined as functional independence measure score of 6 or higher (complete independence) in at least two domains among eating, bladder management, and transfers. Between 1992 and 2016, 1090 patients with low cervical SCI and complete neurological/functional measures were included. At baseline, 67% of patients had complete SCI and 33% had incomplete SCI. The majority of patients were dependent in eating, bladder management, and transfers. At one-year follow-up, the largest proportion of patients who recovered motor function in finger flexion (C8) and elbow extension (C7) gained independence in eating, bladder management, and transfers. In multi-variable analysis, patients who had recovered finger flexion (C8) or elbow extension (C7) had higher odds of gaining independence in a composite of major ADLs (odds ratio [OR] = 3.13 and OR = 2.87, respectively, p < 0.001). Age 60 years (OR = 0.44, p = 0.01), and complete SCI (OR = 0.43, p = 0.002) were associated with reduced odds of gaining independence in ADLs. After cervical SCI, finger flexion (C8) and elbow extension (C7) recovery translate into greater independence in eating, bladder management, and transfers. These results can be used to design individualized reinnervation plans to reanimate upper limb function and maximize independence in patients with low cervical SCI.

Cervical spinal cord compression from subdural hematoma caused by traumatic nerve root avulsion: illustrative case

BACKGROUND

Posttraumatic intradural hematomas of the cervical spine are rare findings that may yield significant neurological deficits if they compress the spinal cord. These compressive hematomas require prompt surgical evacuation. In certain instances, intradural hematomas may form from avulsion of cervical nerve roots.

OBSERVATIONS

The authors present the case of a 29-year-old male who presented with right upper-extremity weakness in the setting of polytrauma after a motor vehicle accident. He had no cervical fractures but subsequently developed right lower-extremity weakness. Magnetic resonance imaging (MRI) demonstrated a compressive hematoma of the cervical spine that was initially read as an epidural hematoma. However, intraoperatively, it was found to be a subdural hematoma, eccentric to the right, stemming from an avulsion of the right C6 nerve root.

LESSONS

Posttraumatic cervical subdural hematomas require rapid surgical evacuation if neurological deficits are present. The source of the hematoma may be an avulsed nerve root, and the associated deficits may be unilateral if the hematoma is eccentric to one side. Surgeons should be prepared for the possibility of an intradural hematoma even in instances in which MRI appears consistent with an epidural hematoma.

An updated management algorithm for incorporating minimally invasive techniques to treat thoracolumbar trauma

OBJECTIVE

Minimally invasive surgery (MIS) techniques can effectively stabilize and decompress many thoracolumbar injuries with decreased morbidity and tissue destruction compared with open approaches. Nonetheless, there is limited direction regarding the breadth and limitations of MIS techniques for thoracolumbar injuries. Consequently, the objectives of this study were to 1) identify the range of current practice patterns for thoracolumbar trauma and 2) integrate expert opinion and literature review to develop an updated treatment algorithm.

METHODS

A survey describing 10 clinical cases with a range of thoracolumbar injuries was sent to 12 surgeons with expertise in spine trauma. The survey results were summarized using descriptive statistics, along with the Fleiss kappa statistic of interrater agreement. To develop an updated treatment algorithm, the authors used a modified Delphi technique that incorporated a literature review, the survey results, and iterative feedback from a group of 14 spine trauma experts. The final algorithm represented the consensus opinion of that expert group.

RESULTS

Eleven of 12 surgeons contacted completed the case survey, including 8 (73%) neurosurgeons and 3 (27%) orthopedic surgeons. For the 4 cases involving patients with neurological deficits, nearly all respondents recommended decompression and fusion, and the proportion recommending open surgery ranged from 55% to 100% by case. Recommendations for the remaining cases were heterogeneous. Among the neurologically intact patients, MIS techniques were typically recommended more often than open techniques. The overall interrater agreement in recommendations was 0.23, indicating fair agreement. Considering both literature review and expert opinion, the updated algorithm indicated that MIS techniques could be used to treat most thoracolumbar injuries. Among neurologically intact patients, percutaneous instrumentation without arthrodesis was recommended for those with AO Spine Thoracolumbar Classification System subtype A3/A4 (Thoracolumbar Injury Classification and Severity Score [TLICS] 4) injuries, but MIS posterior arthrodesis was recommended for most patients with AO Spine subtype B2/B3 (TLICS > 4) injuries. Depending on vertebral body integrity, anterolateral corpectomy or mini-open decompression could be used for patients with neurological deficits.

CONCLUSIONS

Spine trauma experts endorsed a range of strategies for treating thoracolumbar injuries but felt that MIS techniques were an option for most patients. The updated treatment algorithm may provide a foundation for surgeons interested in safe approaches for using MIS techniques to treat thoracolumbar trauma.

Incidence and predictors of post-traumatic stress symptoms in a cohort of patients with intracerebral hemorrhage

OBJECTIVES

Examine the incidence and predictors of PTSD symptoms in a cohort of patients with ICH.

PATIENTS AND METHODS

This study uses a prospective cohort of 108 patients with complete follow-up data including a questionnaire regarding stress symptoms (PCL-S: PTSD checklist specific for a stressor) at 3, 6, and 12 months.

RESULTS

The incidence of novel stress symptoms following ICH was approximately 6.5%. Age was negatively associated with PTSD symptoms with only trend-level significance (3 months: OR = 0.83, p = 0.087; 6 months: OR = 0.70, p = 0.015; 12 months: OR = 0.88, p =  0.087). Gender did not affect PTSD symptom development, (t = 1.34, p =  0.18). Pre-morbid functioning, initial stroke prognosis, total number of complications, and length of hospital/ICU stay were not associated with PTSD symptoms; however, each was significantly correlated with poorer functional outcomes. Yet, poorer functional outcomes were observed in those with higher reports of PTSD symptoms (r = 0.24, p = 0.01).

CONCLUSION

Functional outcomes in ICH are correlated with PTSD symptoms, however the mechanism and relationship are difficult to elucidate. Further research is needed to determine possible mechanisms by which a stroke patient may develop PTSD.

The Intracerebral Hemorrhage Score: Changing Perspectives on Mortality and Disability

BACKGROUND

Intracerebral hemorrhage (ICH) remains a devastating diagnosis. While the ICH Score continues to be used in the clinical setting to prognosticate outcomes, contemporary improvements in management have reduced mortality rates for each scoring tier. The aims of this study were to examine mortality rates within ICH Score strata and examine if these findings are stable when major disability is included in categorizing poor outcomes.

METHODS

From a single-institution cohort built between 2009 and 2016, 582 patients were extracted based on the criteria for complete ICH Score, discharge mortality, and functional status for survivors. Mortality rates were stratified by ICH Score and compared with both historical and similar contemporary cohorts. Poor outcome was defined as severe disability (modified Rankin Scale score 5) in addition to death, stratified by ICH Score, and compared. A secondary analysis of patients with ICH Score of 2 was performed in light of the primary results.

RESULTS

Mortality rates stratified by ICH Score were notably lower than expected for low- and moderate-grade ICH compared with the original cohort. However, when defining a poor outcome as including severe disability (modified Rankin Scale score 5) in addition to death, the rates for poor outcomes were higher for patients with ICH Score of 2 (51.16% vs. 26%, P = 0.017) and no different for any other score group compared with the original cohort.

CONCLUSIONS

Though the original ICH Score overestimates mortality for low-grade and moderate-grade hemorrhages, it may underpredict severe disability.

Comparison of Laryngeal Mask Airway with Tracheal Tube for Ophthalmic Surgery in Paediatric Patients

This study of sixty ASA grade 1 or 2 children, aged 1 to 12 years, undergoing elective ophthalmic procedures, compared the use of the laryngeal mask airway (LMA) with that of an endotracheal tube. Changes in intraocular pressure and haemodynamic parameters, and intraoperative and postoperative complications were measured. Patients were randomly allocated into two groups of 30 patients. In group 1, the airway was secured with an LMA and in group 2 with an endotracheal tube. A standard technique of general anaesthesia incorporating positive pressure ventilation was used in both groups. The changes in intraocular pressure, heart rate (HR) and mean arterial pressure (MAP) were observed before and after insertion of the airway device, two minutes after insertion, and pre and post removal of the device. The incidence of airway complications was also noted. There was no significant change in mean intraocular pressure after insertion of the LMA, but removal caused a significant increase to 19.3± 7.6 mmHg (from a baseline of 13.9±4.3 mmHg). In the endotracheal tube group, intubation increased the mean intraocular pressure significantly to 19.9±7.3 mmHg (from a baseline of 13.1±4.0 mmHg) and extubation caused an increase to 24.6±10.4 mmHg which was clinically as well as statistically significant. The incidence of postoperative coughing was lower in the LMA group, but the incidence of vomiting higher. Two patients had displacement of the LMA during the procedure. We conclude that the use of an LMA is associated with less increase in intraocular pressure than the use of an endotracheal tube in children.

Free radical scavenging potential of sericin obtained from various ecoraces of tasar cocoons and its cosmeceuticals implication

Tropical tasar silkworm Antheraea mylitta is a wild sericigenous insect which is distributed in different geographical regions and named as different ecoraces. In the present study, we investigated the molecular characterisation and cosmeceutical properties of sericin extracted from different ecoraces of tasar cocoons. The surface morphology and molecular weight of cocoons were determined by scanning electron microscope (SEM) and SDS-PAGE, respectively. Characterisation of sericin was performed by various methods such as FTIR, CHNS, TGA and amino acid analyzer. The anti-tyrosinase, anti-elastase, glutathione-S-transferase inhibition, free radical scavenging potential and inhibition of oxidative damages were measured in tasar ecoraces sericin. SEM images have revealed the removal of sericin from the surface of cocoons. SDS-PAGE of sericin depicted the presence of diverse molecular weight of proteins. Structural determination by FTIR revealed the presence of both α-helical and β-sheet structures. Thermal properties of sericin were studied by TGA which showed a 50% weight loss at temperature 410 °C-430 °C. Additionally, ecoraces sericin contains 17 amino acids in which serine, aspartic acid and glycine are predominantly present (55.68-59.61%). Further, anti-tyrosinase, anti-elastase, inhibition of glutathione-S-transferase activity, free radical scavenging potential and inhibition of lipid peroxidation were also observed in ecoraces sericin. Our findings suggest that the present study appear to be helpful in exploiting sericin as potential biomaterial in cosmeceutical and allied field.

Tasar silk fiber waste sericin: New source for anti-elastase, anti-tyrosinase and anti-oxidant compounds

The present study investigates the properties of sericin extracted from tasar silk fiber waste (TSFW). The surface morphology of TSFW was observed by scanning electron microscope (SEM). SEM images revealed the removal of residual sericin over the surface of TSFW. The molecular weight distribution of sericin was examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The results suggested that TSFW sericin represented a family of proteins with wide-ranging molecular weight distribution (11-245 kDa). Structural determination by FTIR revealed the presence of both α-helical and β-sheet structures. The colour was studied by colorimeter indicating less brightness, more red and yellow colour intensities. The carbon: nitrogen ratio (C:N) was studied by CHNS element analyzer and the ratio is 5.15-7.85. Thermal properties of TSFW sericin have been studied by thermogravimetric analysis (TGA) method. TGA curve showed higher thermal stability and variable degradation profiles. Furthermore, TSFW sericin contains 17 amino acids where serine, aspartic acid and glycine are the more significant compounds (54.34-60.49%). In addition, sericin was found to inhibit tyrosinase, elastase and glutathione-S-transferase activity, and had apparent radical scavenging impacts on 2.2‑diphenyl‑1‑picryl‑hydrazil (DPPH), hydrogen peroxide and inhibition of lipid peroxidation. Result suggested that TSFW sericins might be a valuable ingredient for cosmoceutical products.

Biomarkers of Functional Outcome in Intracerebral Hemorrhage: Interplay between Clinical Metrics, CD163, and Ferritin

BACKGROUND

Intracerebral hemorrhage (ICH) is associated with neurological decline and poor prognosis. Although many etiologic models have been explored, secondary damage caused by continued inflammation and iron exposure from red blood cell lysis may explain poor outcomes at distant follow-up. Examining serum samples of patients with ICH for biomarkers of iron physiology may yield relationships between iron exposure and functional outcomes.

METHODS

The following study retrospectively evaluated 41 patient serum samples obtained 1 day and 7 days post-ictus for CD163, ferritin, and hepcidin concentrations. Functional outcomes, using the modified Rankin Scale, were dichotomized into good (0-3) and poor (4-6). Correlation analysis and logistic regression were used to explore relationships between biomarker values, clinical metrics (such as ICH Score), and functional outcomes at 3 and 12 months.

RESULTS

Clinical metrics (Acute Physiology and Chronic Health Evaluation II score, ICH Score, and National Institutes of Health Stroke Scale) were correlated with elevated ferritin levels 7 days post-ictus. Furthermore, it was found that mean CD163 levels on day 1 were significantly associated with functional outcomes at 3 and 12 months; mean serum ferritin concentrations on days 1 and 7 were elevated in those with poor outcomes at 3 months, and day 7 levels were independently correlated with 12-month outcomes.

CONCLUSION

Although this study serves to contribute to a growing body of evidence that CD163 and ferritin are biomarkers of functional outcomes, prospective cohort studies may clarify the role of iron-related inflammatory biomarkers as they pertain to neurological decline in patients with ICH.

Prognosticating Functional Outcome After Intracerebral Hemorrhage: The ICHOP Score

BACKGROUND

The morbidity, mortality, and monetary cost associated with intracerebral hemorrhage (ICH) is devastatingly high. Several scoring systems have been proposed to prognosticate outcomes after ICH, although the original ICH Score is still the most widely used. However, recent research suggests that systemic physiologic factors, such as those included in the Acute Physiology and Chronic Health Evaluation II score, may also influence outcome. In addition, no scoring systems to date have included premorbid functional status. Therefore, we propose a scoring system that incorporates these factors to prognosticate 3-month and 12-month functional outcomes.

METHODS

We used the Random Forest machine-learning technique to identify factors from a dataset of more than 200 data points per patient that were most strongly affiliated with functional outcome. We then used linear regression to create an initial model based on these factors and modified weightings to improve accuracy. Our scoring system was compared with the ICH Score for prognosticating functional outcomes.

RESULTS

Two separate scoring systems (Intracerebral Hemorrhage Outcomes Project 3 [ICHOP₃] and ICHOP₁₂) were developed for 3-month and 12-month functional outcomes using Glasgow Coma Scale, National Institutes of Health Stroke Scale, Acute Physiology and Chronic Health Evaluation II, premorbid modified Rankin Scale (mRS), and hematoma volume (3-month only). Patient outcomes were dichotomized into good (mRS score, 0-3) and poor (mRS score, 4-6) categories based on functional status. Areas under the curve in the derivation cohort for predicting mRS score were 0.89 (3-month) and 0.87 (12-month); both were significantly more discriminatory than the original ICH Score.

CONCLUSIONS

The ICHOP scores may provide more comprehensive evaluation of a patient's long-term functional prognosis by taking into account systemic physiologic factors as well as premorbid functional status.

Computerized spiral analysis using the iPad

BACKGROUND

Digital analysis of writing and drawing has become a valuable research and clinical tool for the study of upper limb motor dysfunction in patients with essential tremor, Parkinson's disease, dystonia, and related disorders. We developed a validated method of computerized spiral analysis of hand-drawn Archimedean spirals that provides insight into movement dynamics beyond subjective visual assessment using a Wacom graphics tablet. While the Wacom tablet method provides robust data, more widely available mobile technology platforms exist.

NEW METHOD

We introduce a novel adaptation of the Wacom-based method for the collection of hand-drawn kinematic data using an Apple iPad. This iPad-based system is stand-alone, easy-to-use, can capture drawing data with either a finger or capacitive stylus, is precise, and potentially ubiquitous.

RESULTS

The iPad-based system acquires position and time data that is fully compatible with our original spiral analysis program. All of the important indices including degree of severity, speed, presence of tremor, tremor amplitude, tremor frequency, variability of pressure, and tightness are calculated from the digital spiral data, which the application is able to transmit.

COMPARISON WITH EXISTING METHOD

While the iPad method is limited by current touch screen technology, it does collect data with acceptable congruence compared to the current Wacom-based method while providing the advantages of accessibility and ease of use.

CONCLUSIONS

The iPad is capable of capturing precise digital spiral data for analysis of motor dysfunction while also providing a convenient, easy-to-use modality in clinics and potentially at home.

Causes of sub-optimal cataract surgical outcomes in patients presenting to a teaching hospital

INTRODUCTION

Surgical treatment for cataract blindness in India is increasing apace; however, sight restoration after surgery is not always satisfactory.

OBJECTIVE

To evaluate visual outcome after cataract surgery and causes of sub-optimal outcome, if any.

MATERIALS AND METHODS

A cross-sectional study including the patients who had undergone cataract surgery six months to ten years ago was carried out. The variables studied were visual acuity, demographic and surgical factors and ocular findings. The causes of subnormal outcome were categorized into cataract surgery-related or unrelated.

STATISTICAL ANALYSIS

SPSS-17 was used; the Chi-square test was used to determine the association between good outcome and categorical variables; the t-test was used for continuous variables. Multivariate analysis using step-wise logistic regression was done.

RESULTS

Among 644 patients (644 eyes), good outcome (presenting visual acuity 6/18 or better) after surgery was seen in 266 (41.3 %) eyes. Good outcome was significantly related to urban residence, presence of an intraocular lens and absence of ocular co-morbidities or posterior capsule opacification. Borderline and poor outcomes were mainly due to surgery related causes; treatable causes included uncorrected refractive errors, and posterior capsule opacification. Intra-operative complications resulting in a pulled-up pupil were frequent.

CONCLUSIONS

Surgical factors are responsible most often for sub-optimal visual outcome; some, like induced astigmatism and vitreous loss, can be modified with training; actively encouraging follow-up visits can allow treatment of residual refractive errors and capsular opacification..

A rare case of homicidal insecticide (organochloro compound) poisoning by intraperitoneal injection

We report a case of a 52-year-old businessman who was allegedly injected with organochloro compound (OC) in his abdomen by his business rivals by means of a surgical needle and a syringe. Homicide by OC injection via an intraperitoneal route has not been reported in the literature. Postmortem findings along with the toxicology report have been discussed particularly in view of the mode of poison administration with a review of literature.

Conformational and vibrational studies of isomeric hydrogen cyanide tetramers by quantum chemical methods

The results of structural studies and detailed harmonic and anharmonic vibrational analysis on two hydrogen cyanide (HCN) tetramers diaminomaleonitrile (DAMN) and diaminofumaronitrile (DAFN), which are important molecules for understanding the chemistry of interstellar space and nitrile rich environments, are being reported on the basis of density functional theory using second-order perturbation theory. Both the molecules are found to have C1 symmetry. While all the heavy atoms of DAMN lie in the same plane (maximum deviation 6°), the two nitrogen atoms in DAFN are out of plane by about 15°. The two amino groups are tetrahedral and do not have significant bond angle anisotropy. Detailed conformational studies are reported on the two molecules and their possible rotational isomers are identified. Complete vibrational analysis based on harmonic and anharmonic frequencies, intensity of infrared and activity of Raman bands and potential energy distribution over the internal coordinates has been provided for the two molecules. Affect of hydrogen bonding on molecular geometry and frequencies of the NH stretch modes has been studied by calculations on the dimers of the two molecules. A close agreement has been observed between the experimental and calculated frequencies. Vibrational-rotational constants such as rotational constants in the ground vibrational state (A0, B0, C0) and the effective rotational constants (Ae, Be and Ce), including terms due to quartic centrifugal distortion constants, rotation-vibration coupling constants, Wilson and Nielsen's centrifugal distortion constants have been calculated using B3LYP and B97-1 functionals and 6-31G**, 6-311+G** and TZVP basis sets.

Persistent high prevalence of cardiovascular risk factors in the urban middle class in India: Jaipur Heart Watch-5

BACKGROUND AND OBJECTIVE

Urban subjects have high burden of cardiovascular risk factors, therefore, to evaluate risk factors in middle socioeconomic subjects and to study secular trends we performed an epidemiological study.

METHODS

The study was performed at urban middle class locations defined according to municipal records in years 2009-10. Stratified random sampling using house-to-house survey was performed. Details of medical history, anthropometry and clinical examination were recorded and biochemical tests performed for estimation of fasting glucose and lipids. Current definitions were used for risk factor classification. Descriptive statistics are provided. Trends were calculated using ANOVA or Mantel Haenszel chi-square. Univariate and multivariate logistic regression was performed to assess risk factor determinants. To determine secular trends we compared risk factors with previous cross-sectional studies performed in same locations in years 2002-3 and 2004-5 in subjects 20-59 years age.

RESULTS

We evaluated 739 subjects (men 451, women 288, response 67%). Age-adjusted prevalence (%) of risk factors in men and women respectively was smoking 95 (21.1) and 12 (4.2), low physical activity 316 (69.6) and 147 (52.3), high fat intake > or = 20 gm/day 278 (73.4) and 171 (68.7), low fruits and vegetables intake < 3 helpings/day 249 (70.3) and 165 (76.4), overweight/obesity 205 (46.2) and 142 (50.7), high waist size 58 (12.9) and 76 (26.6), high waist:hip 143 (31.9) and 154 (53.9), hypertension 177 (39.5) and 71 (24.6), high total cholesterol > or = 200 mg/ dl 148 (33.0) and 93 (32.7), low HDL cholesterol < 40/50 mg/dl 113 (25.1) and 157 (55.3), diabetes 62 (15.5) and 25 (10.8) and metabolic syndrome 109 (25.1) and 61 (22.0). Age-associated increase was observed in body mass index, waist size, waist ratio:hip, systolic blood pressure and fasting and total cholesterol, non-HDL cholesterol and triglycerides in women (Ptrend < 0.01). Age related increase was also observed in prevalence of obesity, truncal obesity, hypertension, diabetes and metabolic syndrome (Ptrend < 0.01). On univariate analysis significant determinants of risk factors were low educational and socioeconomic status for smoking, high fat diet for obesity and hypertension, low fruits and vegetables intake for metabolic syndrome, and low physical activity or obesity but on age-and sex-adjusted multivariate analysis only association was high fat diet with obesity and hypertension (logistic regression analysis p < 0.05). Compared to studies performed at similar locations in years 2002-03 and 2005-06 there was increasing trend in prevalence of high non-HDL cholesterol and hypertriglyceridemia (Ptrend < 0.05) while other risk factors did not change significantly.

CONCLUSIONS

There is a high prevalence of multiple cardiovascular risk factors in Indian middle class individuals. Secular trends demonstrate a persistent high prevalence and increasing non-HDL cholesterol and triglycerides over 8-year period.

Twenty-year trends in cardiovascular risk factors in India and influence of educational status

BACKGROUND

Urban middle-socioeconomic status (SES) subjects have high burden of cardiovascular risk factors in low-income countries. To determine secular trends in risk factors among this population and to correlate risks with educational status we performed epidemiological studies in India.

METHODS

Five cross-sectional studies were performed in middle-SES urban locations in Jaipur, India from years 1992 to 2010. Cluster sampling was performed. Subjects (men, women) aged 20-59 years evaluated were 712 (459, 253) in 1992-94, 558 (286, 272) in 1999-2001, 374 (179, 195) in 2002-03, 887 (414, 473) in 2004-05, and 530 (324, 206) in 2009-10. Data were obtained by history, anthropometry, and fasting blood glucose and lipids estimation. Response rates varied from 55 to 75%. Mean values and risk factor prevalence were determined. Secular trends were identified using quadratic and log-linear regression and chi-squared for trend.

RESULTS

Across the studies, there was high prevalence of overweight, hypertension, and lipid abnormalities. Age- and sex-adjusted trends showed significant increases in mean body mass index (BMI), fasting glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides (quadratic and log-linear regression, p < 0.001). Systolic blood pressure (BP) decreased while insignificant changes were observed for waist-hip ratio and low-density lipoprotein (LDL) cholesterol. Categorical trends showed increase in overweight and decrease in smoking (p < 0.05); insignificant changes were observed in truncal obesity, hypertension, hypercholesterolaemia, and diabetes. Adjustment for educational status attenuated linear trends in BMI and total and LDL cholesterol and accentuated trends in systolic BP, glucose, and HDL cholesterol. There was significant association of an increase in education with decline in smoking and an increase in overweight (two-line regression p < 0.05).

CONCLUSION

In Indian urban middle-SES subjects there is high prevalence of cardiovascular risk factors. Over a 20-year period BMI and overweight increased, smoking and systolic BP decreased, and truncal obesity, hypercholesterolaemia, and diabetes remained stable. Increasing educational status attenuated trends for systolic BP, glucose and HDL cholesterol, and BMI.

Structure and vibrational spectra of some 8-oxa[5]helicenes

A systematic study has been conducted on the geometrical and electronic structure, heliomeric conformations of a series of 8-oxa[5]helicenes based on density functional theory (DFT) computations. A complete vibrational analysis has also been attempted for one of the 8-oxa[5]helicenes (molecule 5) on the basis of experimental infrared spectra in the far and mid infrared regions (60-3100 cm(-1)) and density functional theory computations using B3LYP/6-31G** method characteristic bands of the molecule identified. The approximate mean plane angle between the terminal rings A and E in the presently studied molecules are found to have values between 48.64° and 59.46°. This angle is much larger than the corresponding angle between the terminal rings in benzo[c]phenanthrene (∼27°) and partially reduced benzo[c]phenanthrene (34.6-46.0°) and indicates that the presence of oxygen-containing six-membered ring provides a greater helicity to the molecules. Detailed quantum chemical study on molecule 4 shows the existence of two enantiomeric forms M- and P- of almost equal energy separated by a potential barrier of 15.55 kcal/mol. It is expected that similar 8-oxa[5]helicines (molecules 3, 5 and 6) may also exist in two enantiomeric forms.

Congenital ectropion uveae with iris coloboma and telecanthus

Congenital ectropion uveae (CEU) is a rare, non progressive anomaly characterised by the presence of iris pigment epithelium on the anterior surface and is frequently associated with anterior iris insertion, dysgenesis of the drainage angle and glaucoma. This paper describes an unusual case of bilateral congenital ectropion uveae with iris coloboma and telecanthus. The anterior chamber angle was normal and there was no evidence of glaucoma. To the best of our knowledge, this association has not been reported previously.

Cardiovascular risk according to educational status in India

OBJECTIVE

Influence of socioeconomic status on cardiovascular risk has not been well studied in low income countries. To determine risks in various educational status (ES) subjects we performed a study in India.

METHODS

Epidemiological study was performed in years 1999-2003 in Jaipur (India) for coronary risk factors among 1280 adults 20-59 years (men 619, women 661). ES was categorized into low (education ≤5 years); middle (6-12 years) and high (>12 years). Prevalence of risk factors and Framingham risk scores were determined.

RESULTS

Low ES was in 306, middle in 436 and high in 538. In low, middle and high ES respectively age-adjusted prevalence (%) of smoking was 19.0, 19.3, and 11.7; obesity 9.5, 16.7, and 22.1, hypertension 15.3, 30.5, and 44.0; hypercholesterolemia ≥200mg/dl 46.0, 48.4, and 54.6; low HDL cholesterol <40mg/dl 46.4, 56.4, and 38.3; metabolic syndrome 20.9, 25.7, and 28.6; and diabetes 6.9, 5.5, and 26.4. Framingham risk score was 5.7±4.8, 6.3±5.7 and 4.7±5.1 and calculated cardiovascular risk probability 5.2±5.7, 6.8±7.8 and 5.2±6.0 (P(trend)<0.05). Framingham risk score was significantly greater in low and middle ES (6.1±5.3) compared to high (4.7±5.1) (p<0.001). Adjustment for smoking attenuated the risk.

CONCLUSION

Low and middle educational status urban subjects in India have greater cardiovascular risk.

Structural and spectroscopic studies on 2-pyranones

Experimental methods of infrared, Raman and electronic absorption spectroscopy and DFT calculations using B3LYP functionals and 6-31G** and 6-311++G** basis sets have been used to understand the structural and spectral characteristics of 2-pyranones, 6-phenyl-4-methylsulfanyl-2-oxo-2H-pyran and 6-phenyl-4-methylsulfanyl-2-oxo-2H-pyran-3-carbonitrile in the electronic ground (S(0)) and first excited (S(1)) states. Information about the size, shape, charge density distribution and site of chemical reactivity of the molecules has been obtained by mapping electron density isosurface with electrostatic potential surfaces (ESP). Based on TD-DFT calculations using 6-31+G**5D basis set, an assignment of absorption peaks in the UV-VIS region has been suggested. The S(1) state is found to be a (1)(pi,pi*) state. A complete vibrational analysis has been attempted on the basis of experimental infrared and Raman spectra and calculated frequency and intensity of the vibrational bands and potential energy distribution over the internal coordinates. Characteristic vibrational bands of the 2-pyranone ring and methylsulfanyl and carbonyl groups have been identified.

Changing trends in otorhinolaryngological diseases at a non-government clinic in Jaipur

BACKGROUND

Otorhinolaryngological (ENT) diseases are major health problem in India but the trends in occurrence of various disorders in clinical practice have not been well studied. To assess the types of such diseases and to determine changing trends in their incidence we performed this study.

METHODS

The study was done at a non-government ENT center at Jaipur. From 1975 to 2005, >125000 patients of different diseases were evaluated here. The study includes randomly selected patients (n = 11454) from years 1980 to 2000 at an interval of 5 years to evaluate disease trends. Significance of trends was evaluated using least squares regression.

RESULTS

In the years 1980, 1985, 1990, 1995 and 2000 mean age of patients was 26.60 ± 17.81 (range 0.16 to 85), 27.07 ± 16.91 (0.08 to 90), 28.30 ± 17.73 (0.25 to 90), 28.79 ± 17.8 (0.25 to 90) and 28.74 ± 17.81 (0.25 to 85) years respectively. 51 types of ENT diseases were observed of which 19 contributed to 76.8% (8807) patients and analysis was restricted to them. Chronic suppurative otitis media (2203, 19.2%), otitis externa (859, 7.5%), deviated nasal septum with nasal obstruction (717, 6.3%) and chronic tonsillitis (695, 6.1%) were the most common, followed by ear wax (569, 4.9%), sensorineural hearing loss (545, 4.7%), chronic rhinosinusitis (428, 3.7%) and epistaxis (320, 2.8%). There was increasing trend for stomatitis (b = 0.0014), deviated nasal septum (b = 0.0290), allergic rhinitis (b = 0.0023), epistaxis (b = 0.0002), acute tonsillitis (b = 0.0003), hoarseness (b = 0.0017), deaf mutism (b = 0.0005), sensorineural hearing loss (b = 0.0038), tinnitus (b = 0.0006) and ear wax (b = 0.0050). Declining trend was observed for chronic rhinosinusitis (b = -0.0155), otitis externa (b = -0.0063), chronic suppurative otitis media (b = -0.0001), acute otitis media ( = -0.0007), secretory otitis media (b = -0.0013), otosclerosis (b = -0.0007), vertigo (b = -0.0007), neck swelling (b = -0.0005) and chronic tonsillitis (b = -0.0194).

CONCLUSION

This study from an Indian urban ENT center shows a significantly increasing trend in chronic and degenerative ear diseases and decline in infection related diseases.

Ab initio and experimental studies on structure and vibrational spectra of some partially reduced benzo[c]phenanthrenes

A systematic study has been conducted on the conformation, electronic structure and vibrational spectra of benzo[c]phenanthrene and some of its partially reduced derivatives by experimental infrared spectroscopic and quantum chemical techniques. Electrostatic potential surfaces have been mapped over the electron density isosurfaces to obtain information about the size, shape, charge density distribution and chemical reactivity of the molecules. Possibility of hydrogen-hydrogen bonding has been explored in all the molecules. Partial reduction of the aromatic rings in benzo[c]phenanthrene leads to considerable molecular distortion with the approximate mean angle between the terminal rings increasing from 27.3 degrees to 46.0 degrees . The distortion is unequally distributed near the aromatic and saturated rings; the latter absorbs most of strain due to flexibility of the rings. A complete vibrational analysis of the experimental infrared spectra has been reported on the basis of frequency and intensity of the vibrational bands and potential energy distribution over the internal coordinates and characteristic bands have been identified.

Obesity is major determinant of coronary risk factors in India: Jaipur Heart Watch studies

OBJECTIVE

The impact of rising population-wide obesity on cardiovascular risk factors has not been well studied in low-income countries. To correlate the prevalence of obesity with risk factors we performed epidemiological studies in India.

METHODS

Multiple cross-sectional epidemiological studies, Jaipur Heart Watch (JHW), were performed in India in rural and urban locations. From these cohorts, subjects aged 20-59 years (men 4102, women 2872) were included. Prevalence of various risk factors: smoking/tobacco use, overweight/obesity (body mass index > or = 25 kg/m2) truncal obesity (waist:hip > or = 0.95 men, > or = 0.85 women), hypertension, dyslipidemias, metabolic syndrome and diabetes was determined. Trends were examined using least squares regression.

RESULTS

Smoking/tobacco use was more in rural men (50.0% vs 40.6%) and urban women (8.9% vs 4.5%, p < 0.01). Obesity, truncal obesity, hypertension, hypercholesterolemia, diabetes, and metabolic syndrome were more in urban cohorts (p < 0.001). Age-adjusted prevalence (%) of obesity in various cohorts, rural JHW, and urban JHW-1, JHW-2, JHW-3, and JHW-4 respectively, in men was 9.4, 21.1, 35.6, 54.0, and 50.9 (r2 = 0.92, p = 0.009) and in women 8.9, 15.7, 45.1, 61.5, and 57.7 (r2 = 0.88, p = 0.018). Prevalence of truncal obesity in men was 3.2, 19.6, 39.6, 41.4, and 31.1 (r2 = 0.60, p = 0.124) and in women 10.1, 49.5, 42.1, 51.7, and 50.5 (r2 = 0.56, p = 0.1467). In successive cohorts increasing trends were observed in the prevalence of hypertension (r2 = 0.93, p = 0.008) and metabolic syndrome (r2 = 0.99, p = 0.005) with weaker trends for hypercholesterolemia (r2 = 0.41, p = 0.241) and diabetes (r2 = 0.79, p = 0.299) in men. In women, significant trends were observed for hypertension (r2 = 0.98, p = 0.001) and weaker trends for others. Increase in generalized obesity correlated significantly with hypertension (two-line regression r2, men 0.91, women 0.88), hypercholesterolemia (0.53, 0.44), metabolic syndrome (0.87, 0.94) and diabetes (0.84, 0.93). Truncal obesity correlated less strongly with the risk factors like hypertension (0.50, 0.57), hypercholesterolemia (0.88, 0.61), metabolic syndrome (0.76, 0.33), and diabetes (0.75, 0.33).

CONCLUSIONS

In Asian Indian subjects, escalating population-wide generalized obesity correlates strongly with increasing cardiovascular risk factors.

Fasting glucose and cardiovascular risk factors in an urban population

OBJECTIVE

To test the hypothesis that blood glucose levels in the range of normoglycemia are associated with increased cardiovascular risk we performed an epidemiological study in an urban population.

METHODS

Randomly selected adults > or = 20 years were studied using stratified sampling. Target sample was 1800 (men 960, women 840) of which 1123 subjects participated. Blood samples were available in 1091 subjects (60.6%, men 532, women 559). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Cardiovascular risk factors were determined using US Adult Treatment Panel-3 guidelines. Pearson's correlation coefficients (r) of fasting glucose with various risk factors were determined. Fasting glucose levels were classified into various groups as < 75 mg/dl, 75-89 mg/dl, 90-109 mg/dl, 110-125 mg/dl and > 126 mg/dl or known diabetes. Prevalence of cardiovascular risk factors was determined in each group.

RESULTS

There was a significant positive correlation of fasting glucose in men and women with body mass index (r = 0.20, 0.12), waist-hip ratio (0.17, 0.09), systolic blood pressure (0.07, 0.22), total cholesterol (0.21, 0.15) and triglycerides (0.21, 0.25). Prevalence (%) of cardiovascular risk factors in men and women was smoking/tobacco use in 37.6 and 11.6, hypertension in 37.0 and 37.6, overweight and obesity in 37.8 and 50.3, truncal obesity in 57.3 and 68.0, high cholesterol > or = 200 mg/dl in 37.4 and 45.8, high triglycerides > or = 150 mg/dl in 32.3 and 28.6 and metabolic syndrome in 22.9 and 31.6 percent. In various groups of fasting glucose there was an increasing trend in prevalence of overweight/obesity, hypertension, hypercholesterolaemia, hypertriglyceridaemia, and metabolic syndrome (Mantel-Haenzel X2 for trend, p < 0.05) and fasting glucose < 75 mg/dl was associated with the lowest prevalence of these risk factors.

CONCLUSIONS

There is a continuous relationship of fasting glucose levels with many cardiovascular risk factors and level < 75 mg/dl is associated with the lowest prevalence.

X-ray crystallographic, spectroscopic and quantum chemical studies on ethyl 2-cyano-3-N ,N-dimethyl amino acrylate

Structural and spectral characteristics of ethyl 2-cyano-3-N,N-dimethyl amino acrylate have been studied by methods of X-ray crystallography, infrared spectroscopy and quantum chemistry. The compound crystallizes in monoclinic space group P2(1)/n with unit cell parameters a=4.26(1)A, b=11.16(1)A, c=19.63(3)A and beta=95.5(1) degrees . The X-ray based three-dimensional structure analysis has been carried out by direct methods and fully refined. Density functional theory calculations for potential energy curves, optimized geometries and vibrational spectra have been carried out using 6-31 G and 6-31 G basis sets and B3LYP functionals. These suggest the possibility of existence of two structural isomers for the molecule-a more stable s-cis and a less stable s-trans isomer, having enthalpy difference of 2.85 kcal/mol. The optimized molecular geometry is in agreement with experimental geometry from X-ray analysis and suggests a preferential s-cis conformation for the molecule in the solid state. Based on experimental and theoretical studies, it may be concluded that the molecule has an almost planar conformation with the cyanide group also lying in the molecular plane; the deviation from planarity does not exceed 3 degrees . The structure is stabilized by the presence of intra-molecular and inter-molecular interactions.

Body-mass index, waist-size, waist-hip ratio and cardiovascular risk factors in urban subejcts

BACKGROUND AND OBJECTIVE

Influence of obesity as determinant of cardiovascular risk factors has not been well studied. To determine association of obesity, measured by body-mass index (BMI), waist-size or waist-hip ratio (WHR), with multiple risk factors in an urban Indian population we performed an epidemiological study.

METHODS

Randomly selected adults > or = 20 years were studied using stratified sampling. Target sample was 1800 (men 960, women 840). 1123 subjects (response 62.4%) were evaluated and blood samples were available in 532 men and 559 women (n=1091, response 60.6%). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Atherosclerosis risk factors were determined using current guidelines. Pearson's correlation coefficients (r) of BMI, waist and WHR with various risk factors were determined. BMI was categorized into five groups: <20.0 Kg/m2, 20.0-22.9, 23.0-24.9, 25.0-29.9, and > or = 30 Kg/m2; waist size was divided into five groups and WHR into six groups in both men and women. Prevalence of cardiovascular risk factors, smoking, hypertension, diabetes, metabolic syndrome and dyslipidaemias was determined in each group and trends analyzed using least-squares regression.

RESULTS

There is a significant positive correlation of BMI, waist-size and WHR with systolic BP (r= 0.46 to 0.13), diastolic BP (0.42 to 0.16), fasting glucose (0.15 to 0.26), and LDL cholesterol (0.16 to 0.03) and negative correlation with physical activity and HDL cholesterol (-0.22 to -0.08) in both men and women (p<0.01). With increasing BMI, waist-size and WHR, prevalence of hypertension, diabetes, and metabolic syndrome increased significantly (p for trend <0.05). WHR increase also correlated significantly with prevalence of high total and LDL cholesterol and triglycerides (p <0.05).

CONCLUSIONS

There is a continuous positive relationship of all markers of obesity (body-mass index, waist size and waist hip ratio) with major coronary risk factors- hypertension, diabetes and metabolic syndrome while WHR also correlates with lipid abnormalities.

Anharmonic analysis of the vibrational spectrum of ketene by density functional theory using second-order perturbative approach

The paper reports main results of a comprehensive study of the vibrational spectrum of ketene computed using second-order perturbation theory treatment based on quartic, cubic and semidiagonal quartic force constants. Two different models--a homogeneous model using the same density functionals and basis functions for the harmonic calculations and anharmonic corrections, and a hybrid model in which the two parts of the calculation are conducted using different density functionals and basis sets--have been employed in the present calculations. Different DFT and CCSD methods and DZ and TZ extended basis sets involving diffuse and polarization functions have been used to calculate optimized and vibrationally averaged geometrical parameters, the harmonic and anharmonic vibrational frequencies and the spectroscopic constants such as anharmonicity constants, rotational constants, rotation-vibration coupling constants, Nielsen's centrifugal distortion constants and Coriolis coupling constants. Homogeneous model is found to be superior to the hybrid model in several respects. Difficulties in the hybrid model may arise due to one of the following reasons: (a) the basic requirement that the geometry optimization and frequency calculations must be done at the same level of theory to have valid frequencies is not met in the hybrid model; (b) the molecular structure gets reoptimized at the low level for anharmonic corrections; (c) in addition, the perturbation could also diverge for the above reasons, particularly for the very low, very anharmonic terms where the harmonic approximation is not close enough to make the perturbation work.

Trends in prevalence of coronary risk factors in an urban Indian population: Jaipur Heart Watch-4

BACKGROUND

To determine prevalence of multiple coronary risk factors in a North Indian Punjabi community and to compare these with previous population based studies in the same city in North India we performed an epidemiological study.

METHODS

A community-based epidemiological study that focused on lifestyle determinants of obesity and its correlates in migrants from Punjab was performed at a single location in Jaipur. A house-to-house enumeration was performed to enroll all adults>or=20 years age in the locality who were then invited for participation in the study. Of the 1400 eligible subjects, 1127 participated (response rate 80.5%, men 556, women 571). Risk factor measurements included smoking or tobacco use, body-mass index (BMI), waist:hip ratio (WHR) and body fat, and in 644 (56.6%) subjects (men 340, women 304) blood examination for fasting blood glucose and lipids. Coronary risk factors were determined using pre-specified criteria.

RESULTS

There was a significant prevalence of risk factors in both men and women respectively with smoking or tobacco use in 209 (37.6%) and 12 (2.2%), obesity (BMI>or=25 kg/m2) in 303 (54.5%) and 350 (61.3%), truncal obesity (high WHR) in 339 (61.0%) and 310 (54.30%), hypertension in 322 (57.9%) and 279 (48.9%), high total cholesterol>or=200 mg/dl in 111 (32.6%) and 120 (39.5%), low HDL cholesterol<40 mg/dl in 103 (30.3%) and 83 (27.3%), high triglycerides>or=150 mg/dl in 146 (42.9%) and 132 (43.4%), metabolic syndrome in 166 (48.8%) and 137 (45.1%), and diabetes in 88 (25.9%) and 64 (21.1%) subjects. In both men and women there was a significant age-associated escalation in obesity, central obesity, hypertension, high cholesterol and diabetes prevalence (Mantel-Haenszel chi2 for trend p<0.05). Logistic regression analyses revealed that obesity and truncal obesity were major determinants of multiple risk factors such as hypertension, hypercholesterolemia, metabolic syndrome and diabetes (age-adjusted odds ratios p<0.01). Comparison with previous population-based risk factor studies from the same city in years 1995 and 2002 revealed that risk factors were significantly greater in the present group. Age-stratified differences revealed that obesity at younger age was more frequent in the present cohort.

CONCLUSIONS

There is a significant prevalence of multiple cardiovascular risk factors in this population group. Obesity is a major determinant of multiple risk factors and appears at a younger age compared to other studies in the same location.

Clinical evaluation of changes in cornea and tear film after surgery for trachomatous upper lid entropion

PURPOSE

To determine the effect of entropion surgery on corneal health in terms of surface epithelium, tear film stability, change in curvature and vision.

METHODS

Prospective study; included consecutive patients with trachomatous upper lid entropion undergoing corrective surgery. Corneal opacity and other conditions that reduced vision were recorded. Best-corrected visual acuity, corneal fluorescein staining, tear film break-up time, Schirmer I test, and keratometry were performed before and after surgery. Data were analysed using Student's t-test, chi(2) test, one-way ANOVA, one-sample t-test, and logistic and multiple regression.

RESULTS

Thirty-six female and 15 male patients with an average age of 59.1+/-10.65 years were included. Lenticular and retinal causes resulted in blindness (P=0.008), and low vision (P=0.02), more often than entropion. At 90 days after surgery, vision improved by 0.55+/-1.48 lines (P=0.01). Superficial punctate staining of the cornea reduced by half over 1-15 days (average 6.96+/-4.99) after surgery, and completely in 1-90 days (average 26.15+/-17.49). Tear film break-up time (range: 3-20 s preoperatively) improved significantly after surgery (P=0.005) whereas Schirmer I (range: 10-35 mm preoperatively) and keratometry values showed insignificant change.

CONCLUSIONS

Surgery for entropion results in healing of superficial keratopathy, improves tear film stability, and the realigned lid margin spreads tears evenly and efficiently, thus contributing to improved vision. These changes, taking place over 1-90 days, should be kept in mind when planning intraocular surgery, keratoplasty, or keratorefractive procedures after entropion correction.

Waist circumference cutoff points and action levels for Asian Indians for identification of abdominal obesity

OBJECTIVE

To test the validity of internationally accepted waist circumference (WC) action levels for adult Asian Indians.

DESIGN

Analysis of data from multisite cross-sectional epidemiological studies in north India.

SUBJECTS

In all, 2050 adult subjects >18 years of age (883 male and 1167 female subjects).

MEASUREMENTS

Body mass index (BMI), WC, waist-to-hip circumference ratio, blood pressure, and fasting samples for blood glucose, total cholesterol, serum triglycerides, and high-density lipoprotein cholesterol.

RESULTS

In male subjects, a WC cutoff point of 78 cm (sensitivity 74.3%, specificity 68.0%), and in female subjects, a cutoff point of 72 cm (sensitivity 68.7%, specificity 71.8%) were appropriate in identifying those with at least one cardiovascular risk factor and for identifying those with a BMI >21 kg/m(2). WC levels of > or =90 and > or =80 cm for men and women, respectively, identified high odds ratio for cardiovascular risk factor(s) and BMI level of > or =25 kg/m(2). The current internationally accepted WC cutoff points (102 cm in men and 88 cm in women) showed lower sensitivity and lower correct classification as compared to the WC cutoff points generated in the present study.

CONCLUSION

We propose the following WC action levels for adult Asian Indians: action level 1: men, > or =78 cm, women, >/=72 cm; and action level 2: men, > or =90 cm, women, > or =80 cm.

Structural and spectroscopic studies on some chloropyrimidine derivatives by experimental and quantum chemical methods

Ab initio quantum chemical and experimental spectroscopic studies in the infrared (4000-60 cm(-1)) and UV spectral regions are being reported on 4-chloro-2,6-dimethylsulfanyl pyrimidine-5-carbonitrile and 4-chloro-2-methylsulfanyl-6-(2-thienyl) pyrimidine-5-carbonitrile. Optimized geometries, electronic charge distribution, dipole moments and three-dimensional molecular electrostatic potential surfaces have been obtained. These have been used to understand the structure and spectral characteristics of the two compounds. A complete assignment of vibrational spectra on the basis of DFT/6-311G** and electronic spectra on the basis of TD-DFT/6-31+G* 5D calculations have been attempted for the two molecules.

Five-year blood pressure trends and regression-to-the-mean in an industrial population

OBJECTIVE

To determine trends in blood pressure (BP) and assess the statistical phenomenon of regression to the mean we performed sequential examinations in an industrial population.

METHODS

All the employees in an industrial plant were examined. Height, weight, body mass index (BMI) and blood pressure were measured using standardised techniques successively for 5 years as part of annual medical check-up of these employees. All the male employees (n=145) were targeted in the first year of which 122 (84.1%) were examined. These numbers declined to 121, 99, 90 and 87 in subsequent years respectively due to employee attrition. Trends in levels of systolic and diastolic BP and hypertension prevalence were examined using standard regression analysis, least-squares regression and graphic analyses using a commercially available statistical programme.

RESULTS

The mean age 31.3 +/- 5.9 years (range 23-41). The mean height was 1.68 + 0.06 m, weight 60.0 + 9.1 kg and BMI 21.2 +/- 3.1 kg/m2. 18 subjects (14.8%) were overweight. From the first to the fifth year, respectively, BMI increased from 21.2 +/- 3.1 kg/m2 to 21.3 +/- 3.9, 21.9 +/- 3.0, 22.3 +/- 3.0 and 22.6 +/- 2.9 kg/m2 (r = 0.93, p = 0.011), systolic BP declined from 127.1 +/- 13.5 to 125.7 +/- 15.4, 125.5 +/- 12.9, 125.0 +/- 12.6 and 124.9 +/- 14.0 mm Hg (r = -0.60, p = 0.034) while diastolic BP remained unchanged (r = 0.15). Prevalence of hypertension (> or =140 / > or =90) declined from 34.4% at baseline to 28.9, 28.3, 24.4 and 24.1% respectively (r = -0.948, p = 0.021).

CONCLUSIONS

A high prevalence of hypertension in observed in this young industrial cohort. Without treatment, the hypertension prevalence as well as mean systolic BP decline over time demonstrating the statistical phenomenon of regression to the mean.

Correlation of regional cardiovascular disease mortality in India with lifestyle and nutritional factors

OBJECTIVE

There is a wide disparity in prevalence and cardiovascular disease mortality in different Indian states. To determine significance of various nutritional factors and other lifestyle variables in explaining this difference in cardiovascular disease mortality we performed an analysis.

METHODS AND RESULTS

Mortality data were obtained from the Registrar General of India. In 1998 the annual death rate for India was 840/100,000 population. Cardiovascular diseases contribute to 27% of these deaths and its crude mortality rate was 227/100,000. Major differences in cardiovascular disease mortality rates in different Indian states were reported varying from 75-100 in sub-Himalayan states of Nagaland, Meghalaya, Himachal Pradesh and Sikkim to a high of 360-430 in Andhra Pradesh, Tamil Nadu, Punjab and Goa. Lifestyle data were obtained from national surveys conducted by the government of India. The second National Family Health Survey (26 states, 92,447 households, 301,984 adults) conducted in 1998-1999 reported on various demographic and lifestyle variables and India Nutrition Profile Study reported dietary intake of 177,841 adults (18 states, 75,229 men, 102,612 women). Cardiovascular disease mortality rates were correlated with smoking, literacy levels, prevalence of stunted growth at 3-years (as marker of fetal undernutrition), adult mean body mass index, prevalence of overweight and obesity, dietary consumption of calories, cereals and pulses, green leafy vegetables, roots, tubers and other vegetables, milk and milk products, fats and oils, and sugar and jaggery. As a major confounder in different states is poverty, all the partial correlation coefficients were adjusted for illiteracy, fertility rate and infant mortality rate. There was a significant positive correlation of cardiovascular disease mortality with prevalence of obesity (R=0.37) and dietary consumption of fats (R=0.67), milk and its products (R=0.27) and sugars (R=0.51) and negative correlation with green leafy vegetable intake (R=-0.42) (p<0.05).

CONCLUSIONS

There are large disparities in cardiovascular disease mortality in different Indian states. This can be epidemiologically explained by difference in dietary consumption of fats, milk, sugar and green-leafy vegetables and prevalence of obesity.

High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3

BACKGROUND

Studies among emigrant Indian populations have shown a high prevalence of obesity and many coronary risk factors in Bhatia community. To determine the prevalence of risk factors in this community within India we performed an epidemiological study.

METHODS AND RESULTS

An ethnic-group sample survey to determine prevalence of cardiovascular risk factors was performed using community registers for enrollment. Methodology used was similar to Jaipur Heart Watch studies performed in 1995 and 2002. We invited 600 randomly selected subjects listed in Punjabi Bhatia community registers and could examine 458 (76.7%) persons (men 226, women 232). Evaluation for coronary risk factors, anthropometric measurements, blood pressure, electrocardiogram, fasting blood glucose and serum lipids was performed using standard definitions. Mean age was 43.2 +/- 14.6 years in men and 44.7 +/- 15.3 years in women. In both men and women there was a high prevalence of family history of coronary heart disease in 45 (19.9%) and 50 (21.6%), family history of diabetes in 96 (42.5%) and 77 (33.2%), sedentary habits in 82 (36.3%) and 73 (31.5%), smoking or tobacco use in 59 (26.1%) and 4 (1.7%), overweight or obesity (body mass index > or = 25 kg/m2) in 123 (54.0%) and 161 (69.4%), severe obesity (body mass index >30 kg/m2) in 47 (20.8%) and 75 (32.3%), truncal obesity (waist-hip ratio: men >0.9, women >0.8) in 175 (77.4%) and 186 (80.2%), increased waist (waist size: men >102 cm, women >88 cm) in 78 (34.5%) and 129 (55.6%), hypertension (blood pressure > or = 140/90 mmHg) in 116 (51.3%) and 120 (51.3%), diabetes in 40 (17.7%) and 33 (14.2%), hypercholesterolemia (total cholesterol > or = 200 mg/dl) in 75 (33.2%) and 67 (28.9%), high triglycerides in 55 (24.3%) and 34 (14.7%), low high-density lipoprotein cholesterol in 169 (74.8%) and 155 (66.8%), and the metabolic syndrome (defined by American National Cholesterol Education Program) in 84 (36.2%) and 111 (47.8%) respectively. Body mass index correlated significantly with (age-adjusted r2 value--men, women) waist diameter (0.52, 0.12), waist-hip ratio (0.21, 0.10), truncal obesity (0.54, 0.60), systolic blood pressure (0.19, 0.16), diastolic blood pressure (0.12, 0.16), hypertension (0.19, 0.31), and metabolic syndrome (0.28, 0.44) (p<0.05). There was a significant linear relationship of body mass index with the prevalence of hypertension, hypercholesterolemia, diabetes (women), and the metabolic syndrome (chi2 for trend p<0.05). Prevalence of these risk factors was the lowest in subjects with body mass index <20 kg/m2. A multivariate ordinal logistic regression analysis revealed that obesity was independently associated with multiple risk factors characterized by metabolic syndrome after adjustment for age, hypertension, and diabetes in both men (odds ratio 2.45, 95% confidence intervals 1.69, 3.57) as well as in women (odds ratio 2.93, 95% confidence intervals 1.86, 4.61) (p<0.01).

CONCLUSIONS

There is a high prevalence of obesity, abdominal obesity, hypertension, diabetes, lipid abnormalities and the metabolic syndrome in this community that is significantly greater than reported studies in Jaipur and urban populations elsewhere in India. Obesity correlates strongly with multiple coronary risk factors of which it is an important determinant.

Conformational stability, optimized geometries, vibrational and electronic spectra of methacryloyl bromide in ground and excited electronic states

In order to understand conformational isomerism in methacryloyl bromide (MABR) in the ground (S(0)) and the first excited (S(1)) electronic states and to interpret the vibrational and electronic spectra of its conformers in the S(0) state, quantum mechanical calculations using Density Functional Theory (DFT) and RHF methods with extended basis sets 6-31G, 6-31G** and 6-311+G(d,p) have been conducted. In RHF calculations, electron correlation effects have been included at the Møller-Plesset MP2 level. It is inferred that in both the electronic states the molecule may exist in two isomeric forms-s-trans and s-cis; the former being more stable than the later by about 1.629 kcal mol(-1) in the S(0) state and by about 2.218 kcal mol(-1) in the S(1) state. Electronic transition tends to increase the s-trans/s-cis and s-cis/s-trans, rotational barriers from 7.059 kcal mol(-1) (2468.1 cm(-1)) and 5.428 kcal mol(-1) (1897.8 cm(-1)) in S(0) state to 23.594 kcal mol(-1) (8249.4 cm(-1)) and 21.376 kcal mol(-1) (7473.9 cm(-1)) in the S(1) state. Completely optimized geometries of the two conformers in S(0) state reveal that while there is no significant difference in their bond lengths, some of the bond angles associated with COBr group are appreciably different. Electronic excitation tends to change both the bond lengths and bond angles. Based on suitably scaled DFT and RHF results obtained from the use of 6-31G** and 6-311+G(d,p) basis sets, a complete assignment is provided to the fundamental vibrational bands of both the s-trans and s-cis conformers in terms of frequency, form and intensity of vibrations and potential distribution across the symmetry coordinates in the S(0) state and a comparison has been made with experimental assignments. A theoretical prediction of the electronic transitions in the near UV-region in the two conformers and their tentative assignment has been provided on the basis of CI level calculations using 6-31G basis set.

Increased variance in blood pressure distribution and changing hypertension prevalence in an urban Indian population

The objective of the study was to determine trends in age-specific blood pressure (BP) distribution and hypertension prevalence in an urban Indian population. In successive hypertension epidemiological studies (1995 and 2002), randomly selected 2212 subjects (1412 men, 797 women) in the first and 1123 subjects (550 men, 573 women) in the second study were evaluated. BP was measured using World Health Organization guidelines and hypertension diagnosed using the American Joint National Committee-VI report. Age-specific BP levels in the first and the second study were determined and compared. The mean values of systolic and diastolic BP were not significantly different in various age groups in the first and the second studies. There was an increased variance in the second study as denoted by the significant increase in standard deviations and coefficients of variation in systolic as well as diastolic BP levels at age groups > or =50 years in men and > or =40 years in women (P<0.05). The age-adjusted prevalence of hypertension (known or BP > or =140/> or =90 mmHg) in the first study was 29.5% (men) and 33.5% (women), and in the second study was 30.0% (men) and 30.3% (women) (P=NS). In the second as compared to the first study, there was decrease in age-adjusted prevalence of stage I hypertension (men 16.8 vs 24.9%, women 15.4 vs 27.5%), and increase in stage II hypertension (men 11.7 vs 2.8%, women 18.8 vs 3.1%), and combined stage II and III hypertension (men 13.5 vs 4.7%, women 16.7 vs 6.0%) (P<0.01). This change was associated with greater prevalence of obesity in the second study. In conclusion, increased systolic and diastolic BP dispersion over a 7-year period in this urban population is associated with unchanged hypertension prevalence, decline in stage I hypertension and upsurge in more severe grades. Increasing environmental factors, particularly obesity, appear important.

Prevalence of diabetes, impaired fasting glucose and insulin resistance syndrome in an urban Indian population

OBJECTIVE

Epidemiological study among urban subjects in western India to determine prevalence of diabetes, insulin resistance syndrome (IRS) and their risk factors.

METHODS

Randomly selected adults > or =20 years were studied using stratified sampling. Target sample was 1,800 (men 960, women 840). 1123 subjects (response 62.4%) were evaluated and blood samples were available in 532 men and 559 women (n=1091, 60.6%). Measurement of anthropometric variables, blood pressure, fasting blood glucose and lipids was performed. Atherosclerosis risk factors were determined using current guidelines. Diabetes was diagnosed when the subject was a known diabetic or fasting blood glucose was > or =126 mg/dl, impaired fasting glucose (IFG) diagnosed when fasting glucose was 110-125 mg/dl. IRS was diagnosed when any three of-IFG, high triglycerides >150 mg/dl, low HDL cholesterol (men<40 mg/dl, women<50 mg/dl), central obesity (men>102 cm, women>88 cm), or high normal blood pressure (>130/>85 mmHg) or hypertension-were present.

RESULTS

Diabetes was present in 70 men (13.2%) and 64 women (11.5%). Age-adjusted prevalence of diabetes was 9.3% in men (95% confidence intervals (CI) 6.7-11.8), 8.1% in women (CI 5.8-10.4) and 8.6% overall (CI 6.9-10.3). IFG was in 28 men (5.3%) and 29 women (5.2%). IRS was present in 52 men (9.8%) and 114 women (20.4%) with age-adjusted prevalence of 7.9% in men (CI 6.7-9.1) and 17.5% in women (CI 14.4-20.6) with an overall prevalence of 12.8% (CI 10.8-14.8). Other metabolic abnormalities of IRS in men and women were high triglycerides in 32.1 and 28.6%, low HDL cholesterol in 54.9 and 90.2%; central obesity in 21.8 and 44.0%, and high normal blood pressure or hypertension in 35.5 and 32.4%. IFG subjects had similar atherosclerosis risk factor profile as normal subjects while those with IRS and diabetes had significantly greater prevalence of obesity, central obesity, hypertension, high triglycerides and low HDL (P<0.01).

CONCLUSIONS

There is s significant prevalence of diabetes and IRS in this urban Indian population. Subjects with diabetes as well as IRS have greater prevalence of obesity, central obesity, hypertension, hypertriglyceridemia and low HDL as compared with normal subjects.

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.

Normal values for inner intercanthal, interpupillary, and outer intercanthal distances in the Indian population

The purpose of this study was to establish a set of normal values for inner intercanthal distance (IICD), interpupillary distance (IPD) and outer intercanthal distance (OICD) in a normal Indian population aged 3-80 years and to find whether the difference between the values of these parameters is statistically significant. We also aimed to compute a regression equation for calculating these. Two thousand five hundred clinically normal Indians were enrolled in the study. A millimeter scale was used to measure IPD and IICD. OICD was measured from the bar reading of Hertel's exophthalmometer. Statistical methods were used to calculate the mean and standard deviation values for these parameters. T-test was applied to determine whether difference between the mean values for these parameters in both sexes was statistically significant or not. A regression equation was also computed to find the values for these parameters in both sexes. The IICD, IPD and OICD ranges for males were 20-36 mm, 46-70 mm and 76-105 mm, and for females 20-36 mm, 46-75 mm and 71-105 mm, respectively The difference between the mean values for these parameters was statistically significant in some age groups but not in others. Gender did not usually influence the normal values for IICD, IPD and OICD in the Indian population. The normal values of these parameters were usually lower than those observed for other races. A knowledge of normal values in this population subgroup can help in studying orbito-cranial growth patterns, syndrome diagnosis, surgical management of cranio-facial deformities and trauma, and manufacture of spectacles.

Fibrous histiocytoma in primary pterygium

Fibrous histiocytoma, a mesenchymal tumor, although reported to develop in various ocular structures with a variable frequency, has never been found within a pterygium. We report the case of a 50-year-old female who had had a pterygium for the last six years and had developed a tumor within it one and a half years ago. The tumor was excised along with the pterygium. On histopathological examination the tumor was found to be a benign fibrous histiocytoma arising from within the pterygium.