Reduced Heart Rate Variability as A Risk Factor for Cardiovascular Disease in Young Healthy Adults with Low and High Body Mass Indexes – A Descriptive Study

Background: Heart rate variability (HRV) is a used to assess autonomic nervous system input to the heart. Studies on the impact of HRV on underweight are limited. Aims/Objectives: To evaluate HRV in age matched young adults of different BMI category. Methodology: This cross-sectional study was done among healthy young adult volunteers between 18 and 25 years of age. Anthropometric variables were measured. ECG was recorded in lead II configuration for 5 minutes. Heart rate variability was analysed with Kubios HRV analyzer. Results: HRV indices were reduced in underweight (UW), overweight (OW) and obese group compared to normal weight (NW) BMI group. Second order polynomial regression between BMI and HF log power in both genders shows an inverted U-shaped relationship with BMI. The association between BMI, waist circumference and body fat (percentage) with HRV indices shows a significant relation to heart rate var-iability among which waist circumference (WC) shows a greater association with HRV indices than BMI. Comparison of HRV parameters among men and women of different BMI group shows female had great-er heart rate variability compared to males across BMI Conclusions: underweight individual also have increased cardiovascular risk like obese group and ab-dominal obesity is better indicator of cardiovascular risk than BMI.

Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia

Background: Cutaneous vasculitis is common, yet the riskfactors for its chronicity have not been established.Objective: To describe the clinical spectrum and identify riskfactors for chronicity of cutaneous vasculitis.Methods: Retrospective data analysis of 275 patientsdiagnosed with cutaneous vasculitis from January 2008 toDecember 2013.Results: The mean age was 33.7 (±17.89) years, with femalepredominance. The majority of patients were Malays (67.3%).Skin biopsy was performed in 110 (40%) patients. Thecommonest sign was palpable purpura (30.6%). Theaetiology remained elusive in 51.3% of patients. Commonidentifiable causes include infection (19.7%) and connectivetissue disease (10.2%). Extracutaneous features were notedin 46.5% of patients. Erythrocyte sedimentation rate andantinuclear antibody were raised in 124 of 170 and 27 of 175patients with documented results respectively. Cutaneousvasculitis was the presenting symptom in seven patientswith newly diagnosed systemic lupus erythematosus. AntiStreptolysin O Titre was positive in 82 of 156 patients withdocumented results. Despite antibiotics, 31.7% of them hadchronic lesions. Prednisolone alone was used in 20% ofpatients while 16.4% needed steroid-sparing agents. Mostpatients who needed systemic therapy (62%) hadunidentifiable aetiology. Among the 155 patients whoremained under follow up, 36.4% had chronic disease, onepatient succumbed due to septicaemia, and the rest fullyrecovered within three months. The presence of ulcerativelesion was significantly associated with developing chronicvasculitis (p=0.003).Conclusion: The clinical spectrum of cutaneous vasculitis inour population was similar to other studies. Ulcerativelesion predicts a chronic outcome

Incidence of cutaneous adverse drug reactions among medical inpatients of Sultanah Aminah Hospital Johor Bahru

Introduction: Cutaneous adverse drug reactions (cADRs) are common. There are only few studies on the incidence of cADRs in Malaysia. Objective: To determine the incidence, clinical features and risk factors of cADRs among hospitalized patients. Methods:A prospective study was conducted among medical inpatients from July to December 2014. Results: A total of 43 cADRs were seen among 11 017 inpatients, yielding an incidence rate of 0.4%. cADR accounted for hospitalization in 26 patients. Previous history of cADR was present in 14 patients, with 50% exposed to the same drug taken previously. Potentially lifethreatening severe cutaneous adverse reactions (SCAR), namely drug reaction with eosinophilia and systemic symptoms (DRESS: 14 cases) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases) comprise almost 50% of cADRs. The commonest culprit drug group was antibiotics (37.2%), followed by anticonvulsants (18.6%). Cotrimoxazole, phenytoin and rifampicin were the main causative drugs for DRESS. Anticonvulsants were most frequently implicated in SJS/TEN (66.7%). Most cases had “probable” causality relationship with suspected drug (69.8%). The majority of cases were of moderate severity (65.1%), while 18.6% had severe reaction with 1 death recorded. Most cases were not preventable (76.7%). Older age (> 60 years) and mucosal involvement were significantly associated with a more severe reaction. Conclusion: The incidence of cADRs was 0.4%, with most cases classified as moderate severity and not preventable. The commonest reaction pattern was DRESS, while the main culprit drug group was antibiotics. Older age and mucosal membrane involvement predicts a severe drug reaction.

Comparative study of the toxicity of 5-fluorouracil-adriamycin-cyclophosphamide versus adriamycin-cyclophosphamide followed by paclitaxel in carcinoma breast.

Context: When cure is possible treatment should be undertaken despite life-threatening toxicities. Fluorouracil-Adriamycin-Cyclophosphamide (FAC) and Adriamycin-Cyclophosphamide (AC-P) are two popular regimens used in the treatment of carcinoma breast and the data regarding the toxicity profile of the AC-P regimen is scarce in the South Indian population. Aims: To study the severity of different types of toxicities seen in patients on FAC and AC-P regimens, to grade the toxicity according to the World Health Organization (WHO) toxicity grading, and to compare the same. Settings and Design: A prospective observational study, with 50 patients in each regimen, was conducted in the Department of Radiotherapy between February 2007 and July 2008. Materials and Methods: The high risk patients received the AC-P regimen and the rest received the FAC regimen. The toxicities developed were graded according to the WHO guidelines. Statistical Analysis Used: The data was analyzed using the chi square test in SPSS 16. Results: Anemia, hyperpigmentation, stomatitis, and diarrhea were significantly high (P < 0.05) in patients receiving the FAC regimen, whereas, leukopenia, myalgia, arthralgia and peripheral neuropathy were significantly high (P <0.05) in patients receiving the AC-P regimen. The Karnofsky performance status was higher in patients receiving the AC-P regimen. Conclusions: Although both the regimens had different toxicity profiles the quality of life was better for patients on the AC-P regimen.

Cardiovascular responses to head-down-body-up postural exercise (Sarvangasana).

Sarvangasana (SVGN) is a head-down-body-up postural exercise in a 'negative g' condition. Though highly recommended as one of the three best of all the asanas it has not yet been studied for its very obvious effects on the cardiovascular (CV) functions. This paper reports the results of the first systematic investigation on SVGN employing echocardiographic analysis in eight healthy male subjects before and after a practice of this asana twice daily for two weeks. The resting heart rate (HR) and left ventricular end-diastolic volume (LVEDV) were significantly reduced (P < 0.02, P < 0.01 respectively) after practising this asana. A tendency toward a mild regression of the left ventricular mass was noticed, though it was not statistically significant. The CV responses to acute 45 degrees head-down tilt (HDT) in a tilt table was not altered after practising this asana. Also there was no orthostatic intolerance during the 3-5 min period of 70 degrees head-up tilt (HUT). These results strongly indicate that further studies of this asana performed for a longer period is most likely to yield very significant observations of applied value.

Usefulness of immunoperoxidase test for serodiagnosis of genital chlamydial infections.

An immunoperoxidase test detecting Chlamydia trachomatis specific serum IgG and IgA antibodies, was carried out to determine its efficacy in establishing chlamydial etiology in 104 clinically diagnosed patients attending a major STD Clinic in Delhi. The patients consisted of 58 with nonspecific urethritis/cervicitis (NSU/NSC), 11 with pelvic inflammatory disease (PID), 23 with primary infertility in either male or female and 12 with lymphogranuloma venereum (LGV). IgG antibodies were tested at a dilution of 1:64 and 1:128 and IgA antibodies at 1:16. Although 27.7 per cent (5 of 18) of the controls had IgG antibodies (> or = 1:128), none had IgA, showing the IgA marker as 100 per cent specific. In 80.8 per cent of all the patients, active infection was detected, 81.0 per cent in NSU/NSC, 81.8 per cent in PID, 76.9 per cent in female infertility, 80 per cent in male infertility and 83.3 per cent in LGV patients. The immunoperoxidase test was found to be an extremely simple and rapid test especially suited for laboratories where facilities are limited.