Tiwari Ranjana, Jain Vikas, Rajput Ajit Singh, Bhagwat A K, Goyal Manish, Tiwari Sakshi.

Background: Obesity is emerging as a serious problem throughout the world, not only among adults but also children, teenagers and young adults. Medical education is stressful throughout the whole course of training. Overweight and obesity is one of the preventable cause of morbidity and mortality. The social implications of obesity are a major problem that is often neglected. Objectives of current study were to assess the prevalence of overweight and obesity in medical students and to assess the factors influencing the development of overweight and obesity. Methods: The present study was a cross sectional study of IInd semester medical students in which, a total of 131 students were included. The study involved administration of a pretested questionnaire to the students and their anthropometric measurements. Results: In a batch of 150 students 131 participated in the study in which 90 (68.70%) were males and 41 (31.30%) were females. The prevalence of overweight was 13 (9.93%) and the prevalence of obesity was 2 (1.53%). Conclusion: The study showed a high prevalence of overweight and obesity among the medical students. At the time of anthropometric measurements awareness was created for their weight and for the promotion of physical activity among medical students.

Indo Heart Survey on latent abnormal glucose regulation in patients with coronary artery disease without diabetes across India.

BACKGROUND: The Euro Heart Survey on diabetes and heart has demonstrated high prevalence of latent glucose abnormalities in non-diabetic patients with coronary artery disease (CAD) in the European population. The aim of our survey was to assess the prevalence of latent abnormal glucose regulation in adult non-diabetic CAD patients in India. METHODS AND RESULTS: Seven centers distributed across India recruited 350 patients. The diagnosis of CAD was done by coronary angiography showing >50% stenosis in any major epicardial coronary artery or its branches. Oral glucose tolerance test (OGTT) and fasting glucose levels were used to characterize glucose metabolism. Venous plasma glucose was measured before (fasting) and 2 hours after ingestion of glucose. Impaired fasting glucose (IFG) was defined as OGTT (0 minute)>or=100 mg/dl but <126 mg/dl and OGTT (2 hours)<140 mg/dl. Impaired glucose tolerance (IGT) was defined as OGTT (0 minute)<126 mg/dl and OGTT (2 hours)>or=140 mg/dl but <200 mg/dl. Of the 350 patients studied, 176 (50.28%) had impaired glucose regulation (IFG-28 [8%]; IGT-148[42.28%]) and 75 (21.42%) had newly detected Diabetes. In all 251 (71.7%) patients with CAD had previously undetected abnormal glucose regulation. CONCLUSION: This survey demonstrates the presence of abnormal glucose regulation in almost three quarters of the non-diabetic Indian CAD patients. OGTT should be recommended as routine screening test for detecting latent glucose abnormalities in all CAD patients.

Early human safety study of turmeric oil (Curcuma longa oil) administered orally in healthy volunteers.

OBJECTIVE: Turmeric extract and turmeric oil have shown chemoprotective effect against chemically-induced malignancies in experimental animals. They can reverse precancerous changes in oral submucous fibrosis in humans. The use of turmeric or Curcuma longa Linn as a spice and household remedy has been known to be safe for centuries. In view of the long term administration required for cancer prevention a Phase I clinical trial of turmeric oil (TO) was designed to study the safety and tolerance of TO in volunteers for a period of 3 months. MATERIAL AND METHODS: Nine healthy volunteers between 20 and 33 years of age were tested for haemoglobin, blood counts, liver and kidney functions, bleeding and clotting time and serum electrolytes initially and at 1 and 3 months of treatment. They were administered 0.6 ml of TO three times a day for 1 month and 1 ml in 3 divided doses for 2 months. The acute tolerability study on Day 1 was conducted in a Clinical Pharmacology daycare Unit. Blood pressure and pulse were recorded frequently on Day 1 and at 24, 48, 72 and 96 hours and fortnightly till 12 weeks. Volunteers were daily supervised for TO intake as well as for any side effects throughout the study period. RESULTS: Nine volunteers were enrolled for the study. One discontinued on 3rd day for allergic skin rashes which, on discontinuation of TO, gradually disappeared by two weeks. Another discontinued on 7th day for intercurrent fever requiring antibiotic treatment. Seven volunteers completed the study. There was no effect of TO, in two doses, on pulse and blood pressure and no side effects in acute tolerability study on Day 1. There was no effect of TO intake on weight, blood pressure, symptoms and signs upto 12 weeks. There was no clinical, haematological, renal or hepatic-toxicity of TO at 1 month and 3 months. Serum lipids did not show significant change except in one volunteer (reversible). CONCLUSIONS: In view of the potential for reversing oral submucous fibrosis, a precancerous condition for oral cancer, TO, can be recommended directly for a Phase II trial in patients.

Ho: Yag laser-assisted lumbar disc decompression: a minimally invasive procedure under local anesthesia.

The morbidity associated with open procedures for lumbar intervertebral disc prolapse has led to the development of minimally invasive techniques. Ho: LADD (Laser-assisted disc decompression) is a very cost-effective minimally invasive procedure. The procedure is carried out under local anesthesia. The patient can be mobilized immediately after the surgery. The study involved 36 cases treated with Ho: LADD for contained lumbar intervertebral disc prolapse. 35 cases were available for follow-up. There was a 91.5% success rate and a minimal complication rate. All cases adhered to strict inclusion and exclusion criteria and were evaluated with the modified Macnab criteria for the assessment of postoperative results.

Candidate gene polymorphisms among North Indians and their association with schizophrenia in a case-control study.

Knowledge of candidate gene polymorphisms in a population is useful for a variety of gene-disease association studies, particularly for some complex traits. A number of candidate genes, a majority of them from the monoaminergic pathway in the brain, have been very popular in association studies with schizophrenia, a neuropsychiatric disorder. In this study diallelic/multiallelic polymorphisms in some dopaminergic, serotonergic and membrane-phospholipid-related genes have been evaluated in a control population recruited from North India. Association, if any, of these allelic variants with schizophrenia has been tested using a case-control approach. The case data have been taken from our published family-based association studies in schizophrenia. Of the eight genes tested in this study, association with schizophrenia was observed for only two gene polymorphisms, one in the promoter region of the serotonin 2A receptor gene and the other in the tryptophan hydroxylase gene. One new allele for the dopamine transporter gene (with eight repeats, 570-bp size), not reported in any population so far, has been identified in one individual in our sample. The data generated in this study, besides providing a normative background for various disease association studies, are a significant contribution to the population-specific genome database, a currently growing requirement.

Limited proteolysis by trypsin influences activity of maize phosphoenolpyruvate carboxylase.

Maize phosphoenolpyruvate carboxylase (PEPC) was rapidly and completely inactivated by very low concentrations of trypsin at 37 degrees C. PEP+Mg2+ and several other effectors of PEP carboxylase offered substantial protection against trypsin inactivation. Inactivation resulted from a fairly specific cleavage of 20 kDa peptide from the enzyme subunit. Limited proteolysis under catalytic condition (in presence of PEP, Mg2+ and HCO3) although yielded a truncated subunit of 90 kDa, did not affect the catalytic function appreciably but desensitized the enzyme to the effectors like glucose-6-phosphate glycine and malate. However, under non-catalytic condition, only malate sensitivity was appreciably affected. Significant protection of the enzyme activity against trypsin during catalytic phase could be either due to a conformational change induced on substrate binding. Several lines of evidence indicate that the inactivation caused by a cleavage at a highly conserved C-terminal end of the subunit.

A study to evaluate the antimicrobial activity of feracrylum and its comparison with povidone-iodine.

Feracrylum, a water-soluble polymer of polyacrylic acid is known for its hemostatic property. Present work is an effort to evaluate its minimum inhibitory concentration (MIC) and compare it with the MIC of povidone-iodine. Ten different species of pathogenic microorganisms were selected, strains of which were obtained from Haffkine Institute. The organisms were maintained under appropriate culture media. The MIC of Freracrylum was determined by using tube culture method where its activity was compared against a standard antimicrobial agent providone-iodine. The study parameters showed that Feracrylum exhibits antimicrobial activity against a wide variety of microorganisms and its efficacy is comparable to that of povidone-iodine.

Modification of maize NADP-malic enzyme by Woodward's reagent 'K'.

Maize leaf NADP-malic enzyme was rapidly inactivated by micromolar concentrations of Woodward's reagent K (WRK). The inactivation followed pseudo-first order reaction kinetics. The order of reaction with respect to WRK was 1, suggesting that inactivation was a consequence of the modification of a single residue per active site. The modified enzyme showed a characteristic absorbance at 346 nm due to carboxyl group modification and also exhibited altered surface charge as seen from the elution profile on "Mono Q" anion exchange column and the mobility on native polyacrylamide gel electrophoresis. Substrate NADP and NADP + Mg2+ strongly protected the enzyme against WRK inactivation indicating that the modified residue may be located at or near the active site. Binding affinity of NADPH to the malic enzyme was studied by the fluorescence technique. The native enzyme binds NADPH strongly resulting in enhancement of the fluorescence emission and also causes a blue shift in the emission maximum of NADPH from 465 nm to 450 nm, however, the modified enzyme neither exhibited the enhancement of fluorescence emission nor the blue shift, indicating loss of NADPH binding site on modification. The essential carboxyl group may be involved in NADPH binding during catalysis by the enzyme.

Short colon variant.

A one day old neonate with a short colon, associated exomphalos minor; bifid scrotum and ileovesical fistula is reported.

Cardiac involvement in systemic sclerosis.

The clinical profile of systemic sclerosis with screening for cardiac involvement and the effect of cold stimulation on myocardium are described in 17 patients. Besides routine investigations, echocardiography, radionuclide ventriculography and computerized stress test, both before and after cold pressor test were done. Ten patients had abnormal ECG findings, two patients had mild pericardial effusion and five patients had moderate grade pulmonary hypertension. Echocardiography and radionuclide ventriculography did not reveal wall motion abnormality either before or after cold stimulation. Computerized stress test was positive for ischaemia following cold stimulation in one patient.

Coronary artery disease in premenopausal Indian women: risk factors and angiographic profile.

Coronary angiographic and clinical profile of 47 premenopausal women presenting with myocardial infarction (MI) or angina is presented. Seventeen patients (36%) had significant obstructive coronary artery disease (CAD) (Group I), while 30 (64%) had normal coronaries (Group II). The latter group included 4 who had MI and 26 who presented with angina. Risk factors in Group I included hypertension (53%), diabetes mellitus (24%), hypercholesterolemia (29%), oral contraceptives and a positive family history (11.8%). Frequency of one, two and three vessel disease was 47%, 18% and 35% respectively. The left anterior descending artery was most commonly affected (82%). In Group II the risk factors included hypertension (17%) and diabetes (7%). No patient in either group was a smoker. This analysis shows that significant obstructive CAD in premenopausal Indian females is more commonly associated with hypertension, diabetes and hypercholesterolemia. Smoking was not encountered and ingestion of contraceptive pills is uncommon.

Thrombotic obstruction of inferior vena cava treated with streptokinase infusion and balloon dilatation.

A 35 year old male with thrombotic obstruction of the inferior vena cava superimposed on a membrane was treated by prolonged (48 hours) infusion of streptokinase followed by balloon membranotomy. The procedure produced excellent clinical, hemodynamic and angiographic results which are sustained at the end of six months.

Percutaneous balloon angioplasty for native coarctation of the aorta. Early and intermediate term results.

We performed balloon angioplasty (BA) in 12 patients with native coarctation of the aorta (COA), aged 2-32 years (average 20.7). The peak systolic gradient across the COA segment decreased from 60.75 +/- 21.85 to 15.66 +/- 9.44 mmHg (p less than 0.001) after the procedure. Angiographically all had more than 50% increase in the diameter of the narrowed segment. During clinical follow up (2.42 months post procedure), all had marked symptomatic benefit. Follow up by haemodynamics and angiography in 4 cases (average 7.7 months post BA) and by echo-doppler in 2 cases (3.6 months post BA) revealed no evidence of aneurysm or restenosis. Our results indicate that BA is a simple, safe, nonoperative alternative to surgery in COA. The immediate and intermediate follow up results are encouraging; however, long term studies are needed to define the true incidence of restenosis and aneurysm.

Clinical and hemodynamic profile of patients with calcific mitral valve disease.

Clinical, hemodynamic and fluoroscopic findings were analysed in 1123 patients with rheumatic mitral valve disease. The incidence of mitral valve calcification was 15 percent (mild 3 percent, moderate 9 percent, and severe 3 percent). There was a male preponderance (male 17 percent, female 5 percent). The presence of moderate to severe degree of calcification of mitral valve correlated with age, rhythm, transmitral gradient, associated mild mitral regurgitation, pulmonary artery pressure, systemic embolisation and previous commissurotomy. No correlation was found between the degree of calcification and presence or absence of other valve lesions.