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Background: In individuals with type 2 diabetes mellitus (T2DM) the presence of Cardiac autonomic neuropathy (CAN) increases the risk of severe hypoglycaemia, cardiac arrhythmias, silent myocardial ischemia and stroke. It is also associated with increased perioperative morbidity and mortality, even with minor surgeries in these patients. The present study was conducted to assess the prevalence of CAN in T2DM patients and to investigate any possible association between CAN and micro vascular complications.Methods: 102 T2DM patients between the age of 30 years and 70 years, who attended outpatient department of Institute of Diabetology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai, Tamil Nadu were included. All the selected patients underwent laboratory investigations, biothesiometry, fundus examination, and CAN assessment by CANS analyser.Results: A slight female preponderance was noted in the study, though it was statistically insignificant. Out of 102 patients, prevalence of CAN dysfunction was found in 82 (80.39%) of T2DM patients. No significant association of CAN was noted with duration of diabetes (p=0.772), HbA1c (p=0.827) and nephropathy (p=0.524). However, peripheral neuropathy (p=0.006) and retinopathy (p=0.03) were found to be significantly associated with CAN in T2DM patients.Conclusions: Prevalence of CAN in asymptomatic South Indian T2DM population was found to be 80.39%, with equal sex distribution and was most common in the 51- 60 years age group. Diabetic neuropathy and retinopathy were the most significant microvascular complications predictive of the incidence of CAN in T2DM patients.
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Background: Nutrient foramen is an opening in the bone shaft which allows passage to the blood vessels of themedullary cavity of a bone for its nourishment and growth. Knowledge about precise location and direction ofthe nutrient artery of long bones is important during any surgical or orthopaedic procedures of limbs, such asbone grafts and microsurgical vascular bone transplantations. This study was carried to record the number,situation and position of nutrient foramina in humerus of adults in south Indian population.Materials and methods: The study was conducted on 85(Right-38, Left-47) humerii collected from AnatomyDepartment of Coimbatore Medical College, Coimbatore. Length of each humerus bone was measured with thehelp of osteometric board. With the help of hand lens bones were observed for the number, direction andlocation of nutrient foramen with respect to the surface and borders.Results: In the present study majority of humerus bones have single nutrient foramen(64.7%) and mainly locatedon the anteromedial surface(51.7%) followed by medial border (36.5%) especially in the middle one third (87.1%)of the humerus.Conclusion: This study may give precise knowledge about location and number of nutrient foramina which isimportant for orthopaedic surgeons during surgical procedures such as fracture repair, bone grafts andmicrosurgeries.
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Purpose: The aim of this study was to establish the prevalence and association of age-related macular degeneration (AMD) and obesity which was not studied extensively in Indian population over 60 years of age. Methods: This was a cross-sectional, population-based study. A total of 4791 patients with gradable fundus photography were included. All patients underwent detailed ophthalmic examination and AMD was graded with retinal photographs. Grading of AMD was done according to the International ARM Epidemiological Study Group and staged based on grading in worse eye. The association of AMD severity and obesity (based on body mass index, waist–hip ratio, waist circumference, isolated abdominal obesity, isolated generalized obesity, and combined obesity) was assessed. The main outcome variable was an association between the presence and severity of AMD with different grades of obesity. Results: No direct significant association was noted between the presence and severity of AMD and any obesity indices. Subgroup analyses based on lifestyle patterns and common systemic pathologies in AMD population were done. Late AMD was significantly associated with tobacco consumption in population with combined obesity (P = 0.033 and odds ratio = 2.998). Conclusion: No direct association was noted between the presence or severity of AMD and obesity in South Indian population. However, indirect associations between the severity of AMD and combined obesity were found.
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Background: Prevalence of Type 2 Diabetes Mellitus in Indian population is on rise and is leading to significant morbidity and mortality. The revised ADA guidelines since 2010 have suggested glycated haemoglobin (HbA1c) as a diagnostic test for Type 2 diabetes. HbA1c level is having geographic and ethnic variability independent of glycaemic status and this has not been extensively studied in many regions. Objective: To study the characteristics of HbA1C in the South Indian population and to determine the cut off value for HbA1C in diagnosing Diabetes in them. Methods: This is a hospital based observational study conducted at a Tertiary care centre in North Kerala. Patients with age ≥30yrs with Fasting Plasma Glucose (FPG) ≥ 100 or Random Plasma Glucose (RPG) ≥ 200 with symptoms of hyperglycaemia with no previous history of anti diabetic treatment were selected for the study. A preset questionnaire was used to collect the data which was later analysed using relevant statistical techniques. Results: Out of the consecutive diabetic patients attending medicine OPD 99 newly detected diabetics/prediabetics who were not under any anti diabetic medications were studied. New onset diabetes/prediabetes patients showed a mean HbA1c of 8.26(SD=2.31). There was no significant correlation of HbA1c values with age, sex and duration of diabetes in the study population. The HbA1c values also had no significant correlation with systolic blood pressure, total cholesterol values or triglyceride levels. However it was significantly related to Fasting plasma glucose, Post prandial plasma glucose and serum LDL cholesterol values. In newly detected diabetic patients (with FPG≥126 taken as gold standard) ROC analysis determined a HbA1c cut off at 6.45% (AUC=0.76, sensitivity=79%, specificity=60%). Conclusion: The study provides a reliable cutoff of glycated haemoglobin (6.45%) among South Indian population which is in accordance with the ADA recommendations.
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Aims: To study the frequency of occurrence of the components of Metabolic Syndrome [MetS] among MetS patients in urban south Indian population, with a view to suggest preventive measures. Study Design: Descriptive hospital based study. Place and Duration of Study: This study was done at a tertiary care teaching institution at Kozhikode, which is an urban area in south India, between September 2007 and February 2008. Methodology: Subjects aged 20 years and above attending the general health check-up clinic (953 people) were screened and people meeting National Cholesterol Education Program Adult Treatment Panel III [NCEP ATP III] criterion for MetS (257 people) were enrolled for the study. In addition to history taking and clinical examination, relevant laboratory investigations were done. Pearson chi-square test was used for statistical analysis. A P value of <0.05 was considered as statistically significant. Results: The prevalence of MetS in the screened population was 27%, more in females (28.1%) than in males (26.4%) and was found to increase with increasing age, in both genders. The most frequently occurring component of MetS in this study was increased abdominal girth [AG]. The other components in the decreasing order of frequency were low high density lipoproteins [HDL], elevated fasting blood glucose [FBG], raised blood pressure [BP] and raised triglycerides [TG]. In males the most frequently occurring component of MetS was reduced HDL, whereas in females it was increased abdominal girth. The other components in the decreasing order of frequency in males were raised TG, increased AG, elevated FBG and raised BP, whereas in females it was low HDL, elevated FBG, raised BP and raised TG. Presence of increased abdominal girth (P<.001) and low HDL (P=.030) was significantly more in females, whereas raised TG (P<.001) was more in males. Conclusions: Increased AG, which is the most frequently occurring component of MetS in this study, is an easily measurable parameter and may be taken as a proxy indicator for the prevalence of MetS in the population. Presence of increased AG is an indicator to check for the presence of other components of MetS and to advise necessary lifestyle changes to prevent the occurrence of MetS and to reduce the cardio vascular disease (CVD) burden in the population.
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Background: The infraorbital foramen is situated in the maxilla and it conveys infraorbital nerve and vessel, the knowledge of its morphometry and variations is therefore mandatory to do therapeutic infraorbital nerve block or any clinical procedures. Aims & Objective: To study the gender wise morphometry of infraorbital foramen and its laterality in dry adult skulls of south Indian population. Materials and Methods: In the present study we examined 100 infraorbital foramina and measured its distance with bony features adjacent to it and the shape, presence of accessory foramina were analysed in relation to gender. The infraorbital foramen was the landmark from which the distance between the following bony structures were examined; Nasion (NAS), Zygomatico-maxillary suture (ZMS), Anterior nasal spine (ANS), and the distance between the inferior orbital rim(IOR) to optic canal (OC), infraorbital foramen IOF), inferior and superior orbital fissure (IF & SF). The average mean and standard deviation were calculated for every measurement. Paired t – test was used to compare the parameters between sides and gender for each measurement. Results: The most common shape of infraorbital foramen found in the present study is oval (39%) followed by semilunar (27%). Round shaped foramen was found in 22% of skulls, triangle shaped foramen was found in 12% and accessory foramina were present in 11% of the skulls. In the present study, we found triangle shaped foramen in 12% skulls and also the number of accessory foramina was found to be higher which emphasise the need to take ethnicity into account as triangle shaped foramen is unique in south Indian population as affirmed by previous authors. Conclusion: The results show significance with respect to gender and side which makes the knowledge of its morphometry obligatory for clinical procedures.
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Introduction: Sex determination from unidentified human skeletal elements is a challenge for forensic investigators and anthropologists. This study aims to detect the best variable for sex determination from different parameters of femur. Materials and Methods: Study was conducted with 75 (40 males and 35 females) femora of known sex from the Department of Anatomy. Eight parameters were measured and subjected to univariate statistics, multivariate analysis such as discriminant analysis and logistic regression analysis employing SPSS 13.00 version program. Results: The epicondylar breadth, antero-posterior diameter of lateral condyle, proximal breadth, vertical diameter of head and neck are statistically significant for dimorphism (p<0.05). Discriminant analysis shows an overall accuracy of 62.7% and stepwise discriminant analysis shows an accuracy of 65.3%.Under stepwise analysis epicondylar breadth was selected as the best discriminant variable for sex prediction. Discussion: Results implies that epicondylar breadth of femur is the best parameter for sex determination which agrees with available literature in different population. It can be correlated to delayed ossification of growing lower end in males giving higher value. Due to early maturity dimorphism is less in the upper end of the bone. Conclusion: The results of present study confirm that epicondylar breadth is one of the good parameters in femur for sexing in unidentified skeleton.
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AIMS: The aim of the present study is to investigate systemic levels of inflammatory markers of cardiovascular diseases like C-reactive protein (CRP), interleukin-6 (IL-6), total leukocyte count and differential count in patients with chronic periodontitis, in comparison to healthy individuals without periodontal disease. SUBJECTS AND METHODS: A total of 42 individuals, both males and females, above the age of 30 years, were included. Healthy controls (Group I, n = 14), patients with chronic localized periodontitis (Group II, n = 14) and chronic generalized periodontitis (Group III, n = 14), all without any other medical disorder were recruited and peripheral blood samples were taken. Serum samples of CRP and IL-6 were estimated by using different techniques. Total leukocyte count and differential count were estimated by standard clinical laboratory method. RESULTS: Groups II and III had higher mean CRP levels than Group I (0.479, 0.544 versus 0.304 mg/dL). C-reactive protein level in Group III was statistically significant when compared to Group I (p = 0.04). Group III had higher median IL-6 level (6.35 pgm/ml) than Group II (< 5.0 pgm/ml) and Group I (< 5.0 pgm/ml). Median values of IL-6 were not statistically significant in any group (p = 0.29). Total leukocyte count was also elevated in Group III (10.4 x 10³/c.mm) compared to Group II and Group I (9.2 x 10³/c.mm and 7.9 x 10³/c.mm). This was statistically significant between different study groups (p < 0.0001). Neutrophil count in Group III was higher (68.0%) than Group II (62.4%) and Group I (57.4%). Neutrophil percentage was statistically significant in Group III, when compared to Group I (p = 0.0003). CONCLUSION: Periodontitis results in higher systemic levels of CRP, IL-6, total leukocyte count and neutrophils. These elevated inflammatory factors may increase inflammatory activity in atherosclerotic lesions, potentially increasing the risk for cardiovascular events.
OBJETIVOS: El objetivo del presente estudio es investigar los niveles sistémicos de los marcadores inflamatorios de enfermedades cardiovasculares, como la proteína C-reactiva (PCR), la interleucina-6 (IL-6), el conteo total de leucocitos, y el conteo diferencial en los pacientes con periodontitis crónica, en comparación con individuos saludables sin la enfermedad periodontal. SUJETOS Y MÉTODOS: El estudio comprendió un total de 42 individuos - varones y hembras - mayores de 30 años de edad. Los controles saludables (Grupo I, un = 14), los individuos con periodontitis crónica localizada (Grupo II, n = 14), y aquellos con periodontitis crónica generalizada (Grupo III, n = 14), todos sin ningún otro problema médico, fueron reclutados y se tomaron muestras de sangre periférica. Las muestras de suero de PCR e IL-6 fueron estimadas usando técnicas diferentes. El conteo total de leucocitos y el conteo diferencial fueron calculados mediante el método estándar de laboratorio clínico. RESULTADOS: Los grupos II y III tuvieron niveles promedio más altos de PCR que el Grupo I (0.479, 0.544 frente a 0.304 mg/dL). El nivel de proteína C-reactiva en el Grupo III fue estadísticamente significativo, comparado con el Grupo I (p = 0.04). El Grupo III tuvo un nivel mediano más alto de IL-6 (6.35 pgm/ml) que el Grupo II (< 5.0 pgm/ml) y el Grupo I (< 5.0 pgm/ml). Los valores medianos de IL-6 no fueron estadísticamente significativos en ningún grupo (p = 0.29). El conteo total de leucocitos también fue elevado en el Grupo III (10.4 x 10³/c.mm) comparado con el Grupo II y el Grupo I (9.2 x 10³/c.mm y 7.9 x 10³/c.mm). Dicho conteo fue estadísticamente significativo entre diferentes grupos de estudio (p < 0.0001). El conteo de neutrófilos en el Grupo III fue más alto (68.0%) que en el Grupo II (62.4%) y el Grupo I (57.4%). El porcentaje de neutrófilos fue estadísticamente significativo en el Grupo III, en comparación con el Grupo I (p = 0.0003). CONCLUSIÓN: La periodontitis produce niveles sistémicos más altos de PCR, IL-6, conteo total de leucocitos y neutrófilos. Estos factores inflamatorios elevados pueden aumentar la actividad inflamatoria en las lesiones ateroscleróticas, aumentando potencialmente el riesgo de accidentes cardiovasculares.
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Adult , Female , Humans , Male , C-Reactive Protein/metabolism , Chronic Periodontitis/blood , /blood , Case-Control Studies , India , Leukocyte Count , NeutrophilsABSTRACT
The seroprevalence of HSV type 1 and 2 both in HIV positive and negative individuals of south India was studied. A comparative analysis was made to study the IgG and IgM antibodies to both types of HSV and the age and gender based distribution of HSV. IgG antibodies were more in HIV positive patients than the IgM antibodies. HSV-1 was more in HIV negative men and in HIV positive men, HSV was predominant than in women. Co infection with both HSV types was more in men. Either HSV-1 or 2 or both were predominant in HIV positive persons of 30 yrs or above than in those below 30 years. HIV negative patients showed high HSV-1 in the age group of 30 and above and high HSV-1 and 2 co infection was found in the age group below 30 yrs. HSV-2 was equally prevalent in both groups. This study helps in the earlier detection of HSV antibodies, which would be useful in immunoprophylaxis.
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Objectives: Even though the constant relation of golden proportion and inner canthal distance (ICD) with the width of the maxillary central incisor (CIW) has been found in European population, it may not be applied to Indian population as we differ from Europeans racially and genetically. Hence, this study was carried out with the objectives of determining if these parameters are applicable to our population also. Materials and Methods: Three hundred south Indian subjects between 18 and 26 years of age, free from facial and dental deformities were examined. Inner canthus of each eye was used as soft tissue landmark. The maxillary central incisors were measured at the contact point area with the help of digital vernier caliper. The CIW was also calculated using golden proportion ratio to obtain the calculated central incisor width. A comparison was made with measured width. Statistical analyses were done to identify any significant difference using "Z" tests. Pearson's Correlation Coefficient test was used to evaluate the measured and the calculated width of the central incisor. Results: ICD and the width of two maxillary incisors were in golden proportion in south Indian population. Also, ICD when multiplied by a decreasing function value of the golden proportion and divided by 2 is a reliable predictor of determining CIW. Conclusion: As in the European population, the ICD and the golden proportion are reliable predictors for determining the width of the maxillary central incisors in the south Indian population also.