Glycated hemoglobin--a public health perspective.

The burden of diabetes mellitus across the world especially in India is substantial, and much of the morbidity and mortality is due to development of diabetic complications. Control of blood glucose is important to reduce occurrence of these complications. Measurement of glycated haemoglobin values provides valuable information about long term glycemic control, and is recommended for routine monitoring by several clinical guidelines on diabetes. Monitoring and appropriate management have been shown to improve outcomes in patients with diabetes in other parts of the world. However, the adoption of glycated hemoglobin as part of routine monitoring of diabetes patients in India will need to answer issues of availability, affordability and accessibility.

Lung function tests in electroplaters of East Delhi.

The presence of high concentration of metals (Cr, Cd, Co, Ni, Pb, etc.) in the work place environments of various types of industries including electroplating units are well known to influence respiratory system. Pulmonary function tests including forced expiratory capacity (FVC), volumes, mechanics and slow vital capacity (SVC) were studied in 80 males, divided into group I and Group II of 40 each were drawn from electroplating and non-electroplating units, respectively from East Delhi factories. The lung function tests were measured using computerized Spiro-232 of P.K. Morgan, Values of majority of lung function parameters such as FEV1/FVC%, FEF50 FEF75, PIFR, FIF50, MVV and SVC were decreased in electroplaters, perhaps due to the exposure to metals and their lower anthropmetric results as compared with non electoplaters. Where as results of TLC, FRC, RV & RV/ TLC% were higher in electroplaters and this may be attributed to higher values of RV in them as compared with non electroplaters.

Lipoprotein(a) as an independent risk factor for coronary artery disease in patients below 40 years of age.

Coronary artery disease has assumed alarming proportions in Indians and often affects people at younger age. Traditional risk factors fail to explain the high incidence of disease. Although lipoprotein(a) has been shown to be a powerful risk factor for atherosclerosis, there is very limited data with regard to its significance in premature coronary artery disease. The present study was therefore undertaken to assess lipoprotein(a) levels and its role as a marker of coronary artery disease in patients below the age of 40 years. Lipid profile and lipoprotein(a) levels were estimated in 50 patients of angiographically proven coronary artery disease and an equal number of age-matched healthy controls. There was no significant difference in the family history of coronary artery disease, body mass index and waist-hip ratio between the two groups. Total plasma cholesterol, triglyceride and LDL-cholesterol levels were significantly higher and HDL-cholesterol significantly lower in patients as compared to controls. In patients of coronary artery disease, mean lipoprotein(a) levels, measured by ELISA method, were 35.0 +/- 32.4 mg/dL and the median was 26.7 mg/dL. These values were significantly higher than the mean of 20.3 +/- 17.0 mg/dL (p < 0.002) and the median of 13.8 mg/dL (p < 0.015) in controls. Multiple regression analysis, to assess the influence of various risk factors, showed that low HDL-cholesterol (odds ratio 4.62, 95% CI 1.84-11.60; p < 0.015) and elevated lipoprotein(a) levels (odds ratio 3.06, 95% CI 1.24-7.55; p < 0.001) were independent risk factors, whereas high total cholesterol and triglyceride levels did not have any independent influence on premature coronary artery disease. Our data thus suggest that lipoprotein (a) levels are elevated and constitute an independent risk factor in patients with premature coronary artery disease below 40 years of age.