Prospective study on sociodynamics of cellulitis in general surgical unit.

Background: Cellulitis is a potentially serious infection that commonly recurs. The identification of preventable dynamic factors could reduce infection related morbidity and cost and improve patient management. The aim of this study was to identify the dynamic factors associated with cellulitis, including analysis of risk factors associated with cellulitis in either limb and in other parts of the body. Methods: We conducted a prospective study on 110 patients with cellulitis in either limb and in other parts of the body, who were admitted in septic ward of all units of King George hospital between period of December 2013 to December 2014. The factors such as low socioeconomic status, illiteracy, rural area, nutritional status and associated co-morbid conditions and their effect on outcome of patient were studied. Univariate analyses were performed to describe the study. Results: The median age of the participants was 62.5 years. The following risk factors were strongly and independently associated with cellulitis and outcome of the patient; illiteracy (OR, 4; P value 0.010), age above 50 years (OR, 0.110; P value 0.000), residing in rural areas (OR, 4.008; P value 0.006), low socioeconomic status (OR, 0.241; P value 0.030) and associated co-morbid conditions (OR, 0.390; P value, 0.032). Conclusion: Patients usually presented in the late stage of disease because of illiteracy, ignorance and poor knowledge. Patients should be educated to routinely inspect their feet, and the importance of appropriate footwear should be emphasized. Patients who are actively involved in their care can improve their quality of life and have a better outcome.

Histopathological changes due to the effect of selenium in experimental cockerels.

Background & objectives: Selenium usually acts as an antioxidant at optimal levels in the body and increased levels are toxic. In this study an attempt was made to evaluate the effect of an optimum dose (0.14 mg) of selenium on histopathological changes in experimental hypercholesterolemia in cockerels. Methods: the effect of selenium (0.14 mg) was investigated on histopathological changes in four tissues namely liver, kidney, heart, and descending aorta in cockerel animal model. Animals were either fed with stock diet (group C), stock diet with cholesterol (group CH), stock diet with selenium (group Se), stock diet, selenium and cholesterol (group CH+Se) for six months. Animals were sacrified and the tissues were isolated and subjected to histopathological study. Results: xanthochromatic collections in liver were observed in group CH; hydropic degeneration in group Se and lobular disarray, hydropic degeneration and kuppfer cell hyperplasia in group CH+Se were observed. In kidney, mild mononuclear infiltration was observed in interstitium in groups CH, Se and CH+Se. myocyte disruption, and mononuclear infiltration in group CH and cCH+Se, and disruption of muscle bundles with vascular congestion in group Se were observed. Smooth muscle proliferation in the media of blood vessel was observed in groups CH, Se and CH+Se. Interpretation & conclusions: Tthe results of the present study suggested that the optimum dose of (140 μg/day) feeding induced atherogenesis by inflammation and smooth muscle proliferation in cockerels with experimentally induced hypercholesterolaemia.

In vitro cardiogenesis can be initiated in human CD34+ cells.

BACKGROUND: The extensive damage that occurs in the cardiac tissue after myocardial infarct is the major concern in post infarct management. It is very well known that adult stem cells mobilized by administration of G-CSF result in homing of stem cells into the damaged myocardium. This is because of the fact that stem cells have the ability to proliferate and capacity to generate into multiple cell lineages. METHOD: A healthy donor was selected as per the guidelines given by the institutional ethical committee and Helsinki declaration. The donor was given G-CSF 5 microg/kg/day and stem cells were harvested from the peripheral blood using Fresenius ASTec204 cell separator. The PBSC were then evaluated by immunohistochemical staining using anti-human CD34 monoclonal antibodies. The cells were then cultured in DMEM with 10% FCS for 17 weeks and in vitro cardiogenesis was initiated by adding 4 microM/l 5'Azacytidine. RESULTS: In vitro cardiogenesis was initiated in pure CD34+ cells with 5' Azacytidine. The cells showed spontaneous beating after 24 hours of treatment and after 5 weeks, the cells connected with the adjoining cells by a myotube. In these cells, expression of myosin light chain (MLC2v) gene and GATA-4 transcription factor validated the development of cardiomyocytes. CONCLUSION: It is observed that the transplantation of autologous stem cells/fetal cardiomyocytes in the heart scar tissue developed due to infarct, limited the scar expansion, and prevented post infarct heart failures. Homing process due to the transplantation of autologous stem cells is time consuming; therefore, transplantation of cardiomyocytes developed from autologous stem cells could be the future method of correcting the infracted myocardium.

Prevalence of coronary artery disease and coronary risk factors in an urban population of Tirupati.

AIMS AND OBJECTIVES: To determine the prevalence of coronary heart disease and its risk factors in the urban population of Tirupati. METHODS: The urban population of Tirupati is spread into 20 wards. Thirteen wards were selected randomly and systematic random sampling was done to identify the sampling unit household. A total of 1519 subjects (539 males and 980 females) 20 years of age formed the sample of the study. Demographic (age, sex, occupation, education and income), behavioral (smoking), anthropometric (height, weight, waist and hip circumferences) and physiological (blood pressure) parameters were noted and recorded and biochemical parameters (serum glucose, total cholesterol, triglycerides, HDL cholesterol levels) were assayed. Coronary artery disease was diagnosed based on history and ECG changes suggestive of ST-segment depression (Minnesota 4-1 to 4-2) or Q wave changes (Minnesota codes 1-1-1 to 1-1-7) or T wave changes (Minnesota codes 5-1 to 5-3). RESULTS: The overall prevalence in the study population was 12.63 (192 cases). In males it was 6.86 (37 cases) and in females 15.81 (155 cases). The major risk factors in this population were central obesity 1003 (66%) [male 320 (59.4%) and females 683 (41.12%)], low HDL cholesterol 709 (46.67%) [male 284 (52.69%) and females 425 (43.36%)], obesity 588 (38.07%) [males 187 (34.32%) and females 403 (41.12%)], high triglyceride levels (>or= 150 mg/dl) 444 (29.22%)[(males 173 (32.09%) and females 272 (27.75%)], high cholesterol levels (>or= 200mg/dl) [(males 127 (23.56%) and females 278 (28.36%)] and hypertension 396 (26.06) [(males 149 (27.64%) and females 247 (25.20%)]. Around a fraction of subjects had metabolic syndrome 371 (24.42%) [(males 90 (16.69%) and females 281 (28.64%)]. In multivariate regression analysis, age (OR 1.05 95% CI 1.01-1.09 p<0.01) and high serum LDL cholesterol level (OR 4.62 95% CI 2.29-9.32 p<0.001) in males and serum triglycerides (OR 1.003 95% CI 1.000-1.005) in females were associated with CAD. CONCLUSIONS: Association of age, high LDL cholesterol in males and triglycerides in females with CAD shows the importance of these risk factors in this population. This was only a cross-sectional study done at one point of time. Clinical importance of these risk factors needs to be tested in the longitudinal study.

Association of serum antioxidants and risk of coronary heart disease in South Indian population.

BACKGROUND AND AIM: Higher prevalence of coronary heart disease (CHD) has been reported in south Indian population, which cannot be accounted for by the traditional risk factors like hyperlipidemia. Identification of new risk factors may help in treatment and prevention of CHD in this part of the world. In an attempt to investigate the causes of increased incidence of CHD in this part of the world, we intended to look for oxidative stress in our patients as a possible risk factor. As an initial step in this perspective, a case- control study was conducted to find out the serum antioxidant levels and their association with CHD in south Indian population. SETTINGS AND DESIGN: A tertiary care hospital; Case--control study. MATERIALS AND METHODS: One hundred thirty nine angiographically proven CHD patients (aged 29-75 years) were studied against 59 population based healthy controls (aged 29-72 years) free of CHD. Fasting serum cholesterol, triglycerides, HDL cholesterol, erythrocyte and plasma glutathione peroxidase and superoxide dismutase were estimated on automated clinical chemistry analyzer. LDL cholesterol and VLDL cholesterol were calculated. Vitamins A and E were estimated using high performance liquid chromatography (HPLC). STATISTICAL ANALYSIS: Unpaired t test was used to compare means. Binary logistic regression was done to find out the association between dependent and independent variables. RESULTS: Significantly higher levels of Total Cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol ratio and lower HDL cholesterol levels were observed in patients when compared to controls. No significant difference of plasma and erythrocyte glutathione peroxidase and superoxide dismutase activity was observed between patients and controls. Significantly lower levels of vitamin E in patients than in controls was observed (P<0.001). Serum vitamin E was inversely associated with coronary heart disease even after controlling for age and other coronary risk factors (Odds ratio 0.898, 95% CI 0.826-0.976 P=0.01). CONCLUSIONS: The results of present study suggest that deficiency of vitamin E may be an independent risk factor of CHD. This study brings out the need for long- term monitoring of vitamin E supplementation as a preventive measure for CHD in the population studied.

Seroprevalence of IgG antibodies to Chlamydia pneumoniae and Helicobacter pylori among coronary heart disease patients and normal individuals in South Indian population.

In recent years, the role of infectious agents in the aetiology of atherosclerotic disease has come to the forefront. In the present study, seroprevalence (IgG) of chlamydia pneumoniae and helicobacter pylori in patients with atherosclerotic coronary heart disease was compared to normal healthy adults. Out of a total of 117 patients 101 had unstable angina (UA) and 16 had chronic stable angina (CSA). C. pneumoniae seropositivity was found in 66% of patients with UA and 94% of CSA patients. The corresponding figures for H. pylori were 58% and 56% respectively. In comparison, 81% of healthy adults were seropositive for C. pneumoniae and 53% for H.pylori. No significant association was found between CHD and the infectious agents. However, this study has revealed a high infection by C. pneumoniae as well as H.pylori in this part of India.

Infectious aetiology in acute coronary syndromes.

PURPOSE: To ascertain the relationship between seropositivity to chronic infections with Helicobacter pylori, Chlamydia pneumoniae and Cytomegalovirus (CMV) and acute coronary syndromes and association of each of these infective agent with biochemical parameters and cardiovascular risk factors. METHODS: The present study was a case-control study involving 117 patients [unstable angina (UA) n=101 and chronic stable angina (CSA) n = 16] attending cardiology clinic. The cases were aged 35-79 years and they were compared with age, sex and socio-economic status matched controls without evidence of coronary artery disease (CAD). RESULTS: Fifty seven (58%) patients with UA and 9(56%) patients with CSA were seropositive for H. pylori. Sixty seven (66%) subjects with UA and 15(94%) patients with CSA subjects were seropositive for C.pneumoniae. Two (2%) patients with USA were seropositive for Cytomegalovirus (CMV). Seropositivity in normal subjects for H. pylori, C. pneumoniae and CMV was 7(43.25%), 10(62.5%) and 1(6.25%) respectively. In linear regression analysis seropositivity of CMV showed positive association with HDL-C (P< 0.05). No significant association of infective agents and coronary syndromes was observed. CONCLUSIONS: Higher levels of lipids, lipoproteins, C-reactive protein and higher percentage of coronary risk factors in patients seropositive for H. pylori in UA suggests the role of infective agents in pathogenesis of atherosclerosis.

Influence of zinc on cardiac and serum biochemical parameters in rabbits.

The pattern of lipid profiles and organic constituents of cardiac and serum tissues of rabbits were studied on treatment with cholesterol, zinc and zinc + cholesterol. Total carbohydrate and total protein levels were decreased with elevated lipid levels in cholesterol fed rabbits. However, the zinc and cholesterol + zinc fed rabbits showed decreased lipid fractions in cardiac and serum tissues leading to reduced atherosclerotic process in rabbits. These results suggest that the zinc is acting as a hypolipidaemic and anti atherogenic agent in experimental rabbits.

Selenium levels in dilated cardiomyopathy.

Thirty-seven dilated cardiomyopathy cases have been studied and compared with 20 normal controls. Serum selenium levels in relation to coronary risk factors were studied. Serum samples were analysed for selenium, total cholesterol, high density lipoprotein(HDL) cholesterol, triglycerides and glucose levels. Smoking, alcohol intake, positive family history, psychosocial tension, obesity, hypercholesterolaemia, hypertriglyceridaemia and hyperglycaemia were found in the following percentages 27%, 8%, 5%, 73%, 41%, 38%, 81%, 46% respectively in dilated cardiomyopathy patients. Low selenium (< 4.5 micrograms/dl) and HDL cholesterol levels and high total cholesterol, triglycerides, low density lipoprotein cholesterol, very low density lipoprotein cholesterol and glucose levels were observed in dilated cardiomyopathy cases compared to controls. The present results support the concept that low selenium levels along with other risk factors play an important role in developing dilated cardiomyopathy.

The role of cadmium in induction of atherosclerosis in rabbits.

Experiments were carried out in rabbits to determine the effects of prolonged treatment of cadmium (8 mg/kg/day) for a period of 6 months on histopathological changes and biochemical alterations of lipid profiles in various tissues compared to normal rabbits. No ECG changes were observed before and at the end of cadmium treatment. Histopathological studies of the coronary artery revealed atherosclerotic changes. Total lipids, cholesterol, free fatty acids and phospholipids were significantly increased in heart and kidney, but decreased in serum and liver. Triglyceride content was increased significantly in heart and kidney with a significant depletion in liver and serum. It is postulated that atherosclerotic changes in rabbits probably occurred through toxic effects of cadmium but the exact mechanism needs to be elucidated.