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.

Utilizing human intelligence in artificial intelligence for detecting glaucomatous fundus images using human-in-the-loop machine learning

Purpose: For diagnosing glaucomatous damage, we have employed a novel convolutional neural network (CNN) from TrueColor confocal fundus images to conquer the black box dilemma in artificial intelligence (AI). This neural network with CNN architecture with human?in?the?loop (HITL) data annotation helps not only in diagnosing glaucoma but also in predicting and locating detailed signs in the glaucomatous fundus, such as splinter hemorrhages, glaucomatous optic atrophy, vertical glaucomatous cupping, peripapillary atrophy, and retinal nerve fiber layer (RNFL) defect. Methods: The training was done on a well?curated private dataset of 1,400 high?resolution confocal fundus images, out of which 1,120 images (80%) were used exclusively for training and 280 images (20%) were used exclusively for testing. A custom trained You Only Look Once version 5 (YOLOv5)?based object detection methodology was used to identify the underlying conditions precisely. Twenty?six predefined medical conditions were annotated by a team of humans (comprising two glaucoma specialists and two optometrists) by using the Microsoft Visual Object Tagging Tool (VoTT) tool. The 280 testing images were split into three groups (90,100, and 90 images) for three test runs done once every 15 days. Results: Test results showed consistent increments in the accuracy, from 94.44% to 98.89%, in predicting the glaucoma diagnosis along with the detailed signs of the glaucomatous fundus. Conclusion: Utilizing human intelligence in AI for detecting glaucomatous fundus images by using HITL machine learning has never been reported in the literature before. This AI model not only has good sensitivity and specificity in accurate glaucoma predictions but is also an explainable AI, thus overcoming the black box dilemma.

Rationale use of Thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports

Abstract INTRODUCTION: Thalidomide is an anti- tumor necrosis factor alpha (TNF-a) drug used mainly in the management of moderate to severe form of Erythema Nodosum Leprosum (ENL). Because of its teratogenic potential it has to be used under proper supervision. Our critical analysis tries to look into the rationale with which it has been used by means of case reports on lepra reaction. METHODS: We looked for the case reports between December 2005 to June 2019 in databases like Pubmed, Embase and other relevant resources. We used search words like "erythema nodosum leprosum(ENL)", "thalidomide", "case report" in different combinations to get relevant reports that focus on thalidomide usage atleast once at any time point during management. The information extracted were indication of thalidomide use, dose, response, outcome, complication if any, along with all the demographic details and geographical distribution. RESULTS: We found 41 case reports eligible for analysis.The information was critically evaluated. From the analysis it was found that 7 of the case report mentioned the exact indication, 4 case report showed irrational use of thalidomide in the case of neuritis without use of steroids, 7 showed proper use of Clofazimine prior to thalidomide initiation, 26 case report showed case report of rationale dose range and in 4 case reports clofazimine was used prior to thalidomide along with the rational dose of thalidomide. CONCLUSIONS: This analysis helps to guide the rationale use of thalidomide focussing on few important points that anyone should keep in mind while managing a case of ENL.

Global Longitudinal Strain Evaluation In Hypertension With And Without Left Ventricular Hypertrophy By Speckle Tracking Echocardiography

Aim:Assessment of Left ventricular (LV) function in hypertensive patients with left ventricular hypertrophy (LVH) and in those without LVH using two dimensional speckle tracking echocardiography (2D-STE).Materials and Methods:Hundred hypertensive patients were included in the study. Of these 50 patients with LVH and 50 patients with non LVH and all had normal left ventricular ejection fraction (LVEF). Two-dimensional conventional and speckle tracking echocardiography was done to all patients to assess left ventricle systolic function and global longitudinal strain.Results:There was no significant difference between hypertensive patients with LVH and without LVH regarding age and sex distribution. There was significantly higher septal wall thickness (1.2±0.3cm p= <0.001), Posterior wall thickness (1.3±0.4cm p=<0.001), and left atrium size (3.9±0.5) in hypertensive patients with LVH (P< 0.001) compared to non LVH patients. GLS (Global Longitudinal Strain) was significantly decreased in patients with systemic hypertension with LVH (−17.4 ± 3.03) compared to no LVH (-19.6±4.6) patients (Pvalue =0.005).Conclusion:This study concluded that there is impairment of left ventricular (LV) systolic function detected by two-dimensional speckle tracking echocardiography in hypertensive patients, especially if associated with LVH with apparently preserved LVsystolic function

Pouteria campechiana leaf extract and its bioactive compound myricitrin are mosquitocidal against Aedes aegypti and Culex quinquefasciatus

Objective: To test the mosquitocidal potential of leaf extracts of Pouteria campechiana prepared with different solvents and elucidate the structure of an isolated mosquitocidal compound. Methods: The leaf extracts of Pouteria campechiana prepared with three solvents (petroleum benzene, ethyl acetate and acetone) and potential bioactive fractions were tested against various stages of Aedes aegypti and Culex quinquefasciatus by using the WHO protocols, and the chemical profile and its functional groups were identified by GC-MS and Fourier transmission-infrared spectroscopy (FT-IR). The structure of bioactive compound was characterized by nuclear magnetic resonance (NMR) spectral technique. Results: The preliminary phytochemical results revealed the presence of alkaloids, amino acids, flavonoids, quinones, saponins, steroids, tannins, and terpenoids in the acetone extract. A significant toxic potential was observed in the acetone extract against both Aedes aegypti and Culex quinquefasciatus mosquitoes. The acetone extract exhibits remarkable larvicidal (LC

Angiographic Profile Of Coronary Artery Disease In Women Undergoing Coronary Angiography In A Tertiary Care Hospital

BACKGROUND: Cardiovascular disease still remains the leading cause of death in women. The clinical and angiographic profiles of women undergoing CAG must be clearly understood. However there is not much data regarding the angiographic pattern of CAD in women undergoing CAG. AIM: Our aim was to study the angiographic pattern of coronary artery disease in women undergoing coronary angiogram in our institute. METHODS: The records of 275 consecutive female patients who underwent CAG in our institute from December 2017 to May 2018 were retrospectively analysed. The clinical and angiographic data were taken for detailed analysis from CAG reports and discharge summaries. Baseline characteristics of patients were noted. Angiographic pattern was analysed. All statistical analysis was performed using SPSS17 software. Ap-value <0.05 was considered statistically significant. RESULTS: In our study group, LAD was the most commonly involved vessel, followed by RCA and LCX respectively.26.91% had normal epicardial coronaries. 9.82% had minimal CAD. 28% had SVD;16.36% had DVD; 15.63% had TVD;21.8% had branch vessel disease. In our study, 7.63% had LMD.1.82% had coronary artery anomalies in the form of abnormal origin. In our study, the prevalence of multi vessel disease (DVD and TVD) is 32% among women undergoing CAG. CONCLUSION: There is a significant increase in the number of women diagnosed to have CAD. Understanding the angiographic pattern of CAD in women will give further insight towards aggressive coronary interventions in women.

Information on Drugs Used in Management of Lepra Reactions in Commonly used Drug Information Sources in India

Availability of adequate and proper drug information helps in rational prescription of essential drugs. This can be obtained from various sources such as National Formularies; other sources such as Current Index of Medical Specialties, Monthly index of medical specialties and the information available with the regulators and drug package inserts (PI). In this study, we assessed the drug information of the drugs used for treatment of both type of lepra reactions. Five drugs used for treating Lepra reactions were analyzed for any variation (Qualitative) in information on various parameters as mentioned in commonly used drug information sources such as CIMS India, MIMS India, Central Drugs and Standards Control Organization (CDSCO) website and National Formulary of India (NFI). We observed some gross qualitative variation regarding drug information given in different commonly used sources. Variation exists in the quality of information available on indications, contraindications, dosage and completeness of the dosing schedule about drugs available in various sources. As management of Lepra reactions is crucial in achievement desirable outcome of treatment of leprosy, it is important that information regarding drugs used for such indications should be 100% uniform in all commonly used and available sources.

Traditional Scrotal Support After Inguino Scrotal Hernia Repair- A Historical Ritual Or A Scientific Myth ???

Scrotal hematoma and edema following an inguinoscrotal hernia surgery is believed to be a common scenario and hence the routine use of scrotal support to reduce the incidence of the hematoma has been a common surgical practice in India. The true incidences of the scrotal edema after these surgeries are not scientifically reported. Aim of the study: 1) To evaluate the efficacy and clinical usage of scrotal support in patients undergoing elective inguinoscrotal surgery in our surgical unit. 2) To measure the true incidences of scrotal hematoma and edema in our surgical unit in a tertiary teaching referral centre. Materials and Methods: A prospective study was performed over a period of one year (March 2016 – March 2017). The study population were divided into two groups, Group-A with simple V shaped under garments and Group-B with conventional scrotal support (coconut bandage). All the surgeries were performed by two surgeons in one surgical unit. The study included all the inguinal hernias except bubonocele, paediatric hernias and recurrent hernias which were excluded from the study. The post operative findings were recorded individually by the surgeons and studied. Results: Total numbers of 156 inguinoscrotal hernia surgeries were performed. Of which, 126 were included in our prospective study. The rest of the cases were excluded based on the exclusion criteria. Of the 126 cases, 66 cases were in Group A and 60 cases were in Group B. All are male patients with the age ranges from 35 – 75 years (Average age 55). There were no significant co-morbidities. All the cases were funicular and complete indirect inguinal hernias. There were no femoral hernias. In Group A, 3 patients ( 3/66) i.e., 4.5% developed scrotal hematoma and edema and in Group B, 6 patients (6/60) i.e., 10% developed similar findings. None of the patients in Group A needed surgical intervention, whereas one patient (1/6) i.e., 1.5% needed surgical intervention. In group B patients, 10 patients (10/60) i.e., 16.6% developed penile edema and 30 patients (30/60) i.e., 50% complained of scrotal discomfort. Conclusion: Our study has shown that routine use of conventional scrotal support should be avoided as it has not reduced the incidences of scrotal hematoma and edema.

Prevalence and Correlates of Disordered Sleep in Southeast Asian Indians with Type 2 Diabetes

BACKGROUND: Sleep disturbances are common in individuals with diabetes. Patients with diabetes have higher rates of insomnia, excessive daytime sleepiness and increased incidence of restless leg syndrome. The purpose of our study was to investigate the prevalence and determine the predictors of sleep dysfunction in patients with type 2 diabetes in a southeast Asian Indian population. METHODS: We enrolled 120 patients with type 2 diabetes who attended an endocrinology clinic in a tertiary-care hospital. After we collected their demographic data, we recorded their anthropometric measurements. Fasting, postprandial blood glucose values and glycosylated hemoglobin (HbA1c) values were then obtained. Quality of sleep was evaluated in all the patients through the Pittsburgh Sleep Quality Index (PSQI), which is a questionnaire that assesses sleep quality and disturbances over a monthlong period. A Global Sleep Quality score > or =5 discriminates between good and poor sleepers. RESULTS: The mean global PSQI score was 7.08 (standard deviation, 3.89), which suggested poor sleep quality in this population. Sixty-nine percent of patients had a global PSQI score > or =5, indicating that they were "poor sleepers." The global PSQI score positively correlated with the duration of diabetes and was also independent of other variables such as age, gender, body mass index, HbA1c, or medications. CONCLUSION: We found a high prevalence of sleep dysfunction in patients with type 2 diabetes. We also found a significant correlation between duration of diabetes and quality of sleep, independent of other variables. It is important for physicians to address the quality and duration of sleep in patients with type 2 diabetes.

Expression of insulin like growth factor binding protein-5 in drug induced human gingival overgrowth.

BACKGROUND & OBJECTIVE: Insulin like growth factor binding proteins (IGFBPs) control the distribution, function and activity of insulin like growth factors (IGFs) in various cells, tissues and body fluids, thereby modulating their metabolic and mitogenic effects. IGFBP-5, the most conserved IGFBP, can function through IGF or directly play a role in fibrosis. Cyclosporine A (CsA) widely used in organ transplant patients, often causes various side effects including gingival fibrotic overgrowth. This study was carried out to assess the mRNA expression of IGFBP-5 in healthy human gingival, chronic periodontitis and CsA induced gingival overgrowth tissues. METHODS: Total RNA was isolated from gingival tissues collected from eight patients with chronic periodontitis, eight patients with CsA induced gingival outgrowth and an equal number of healthy individuals, and subjected to reverse transcription (RT)-PCR for IGFBP-5 gene expression. RESULTS: CsA induced gingival overgrowth tissues expressed increased IGFBP-5 mRNA compared to control and chronic periodontitis. INTERPRETATION & CONCLUSION: Increased mRNA expression of IGFBP-5 in CsA induced gingival outgrowth tissues may be associated with increased collagen synthesis, thereby promoting fibrogenesis.

Expression of Toll-like receptors 2 and 4 in gingivitis and chronic periodontitis.

Periodontal disease is the major cause of adult tooth loss and is commonly characterized by a chronic inflammation caused by infection by oral bacteria. Members of Toll-like receptor (TLR) family recognize conserved microbial structures, such as bacterial lipopolysaccharides, and activate signaling pathways that result in immune responses against microbial infections. The aim of the present study was to assess the mRNA expression of TLR-2 and TLR-4 in gingivitis and chronic periodontitis. Gingival tissue samples were collected from patients with chronic periodontitis, gingivitis, and healthy controls. Total RNA was extracted and RT-PCR was done for TLR-2 and TLR-4. The results showed that TLR-2 was significantly increased in gingivitis compared to TLR-4 expression and decreased in chronic periodontitis.