Echocardiographic Changes in Type 2 Diabetes Mellitus with Reference to Body Mass Index and Waist Hip Ratio

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycaemia. India alone had 65.1 million diabetics by the year 2013. DM with high BMI & increased central obesity (WHR) have changes in the cardiac geometry evidenced in echocardiography. AIM OF STUDY: Estimation of Body Mass Index (BMI) and Waist Hip Ratio (WHR) & Establish a relationship between obesity, particularly central obesity in type 2 diabetes mellitus patients and cardiac changes with the help of echocardiography.  Methods: 30 Subjects with type 2 DM attending the OPD or admitted in Katihar Medical College indoor department & 30 control patients were also be taken from the same, all of age >40 years. The cases and the controls were examined thoroughly with respect to BMI (>30) & WHR (> 0.85 for females and > 0.95 for males) and echocardiography was done. Results: The cases i.e. type 2 diabetes with high WHR and BMI had highly significant alteration in LV geometry as compared to the controls & had significantly high mean LV mass 189.10grams as compared to 134.04 grams of the controls. There was significant early diastolic dysfunction found in the cases group while no significant difference was found in systolic dysfunction between cases & controls. The incidence of changes in left ventricular geometry was higher in female type 2 diabetic subjects with high waist hip ratio and BMI as compared to males. Conclusions: Form the data of the present study it can be concluded that type 2 diabetics with obesity, particularly central type, have an increased predisposition to the development of left ventricular structural or geometrical abnormality. They have significantly higher left ventricular Mass. Obese type 2 diabetics also have higher incidence of diastolic dysfunction. All these abnormalities occur with greater frequency in females. Thus, type 2 diabetics with high BMI and Waist hip ratio have higher risk of development of cardiovascular disease, which is higher for female than males.

A comparative study of tracheal intubation characteristics using Macintosh and Airtraq laryngoscope.

Background: Direct laryngoscopy for endotracheal intubation with the Macintosh blade is most commonly used for establishing a patent airway. AirtraqTm Optical Laryngoscope, does not require the alignment of the 3 airway axes for glottic visualization. Objective: We aim to compare these two laryngoscopes in view of laryngoscopic grading, ease of tracheal intubation and hemodynamic changes associated with laryngoscopy and intubation. Materials and Methods: 50 ASA I and II patients were randomly divided into Macintosh (M) group and Airtraq (A) group. Cormack Lehane grading, ease of intubation, laryngeal intubation time in secs and incidence of sore throat was noted. HR & BP was recorded at 0, 1, 3, 5 & 10 minutes following intubation. Unpaired ‘t’ test compared inter-group data, while paired ‘t’ test compared within group cardiovascular data. (p<0.05 statistically significant) Results: The demographic data of both groups were comparable. Cormack- Lehane grading was better in group A than in group M [grade I group A(84%) and group M(60%)]. The mean time for laryngeal intubation (Mean ± SD) for group A (8.3 ± 4.6 secs) and group M (20.46 ± 6.6 secs) (t = 7.6, p< 0.01). Ease of intubation was better in group A than group M. The rise in blood pressure and heart rate was significantly less in Group A as compared to Group M. Conclusion: Airtraq laryngoscope was superior to Macintosh laryngoscope as it provided better laryngoscopic views, shorter laryngoscopy and intubation time, easier intubation and the rise in heart rate and systolic blood pressure was significantly less.

A study on delivery and newborn care practices in a rural block of West Bengal.

A cross-sectional study was conducted in a rural block of the State of West Bengal to generate area specific data on the proportion of home deliveries and certain newborn care practices prevalent in that area. The study was done through house-to-house survey among 165 mothers who delivered in last six months. 83.6% deliveries were conducted at home and untrained persons attended 36.3% deliveries. Bath within 24 hours of delivery was given to 17.58% newborns. Birthweight was not recorded in 38.18%. High proportion of newborns, 78.5%, was given prelacteal feeding. The health system should urgently address the deficiencies in the delivery and newborn care practices in the study area.

Hemophagoctic lymphohistiocytosis--recent concept.

Hemophagocytic lymphohistiocytosis is a rare condition characterized by highly stimulated but inactive immune response. The disease may be inherited or acquired due to infections, collagen vascular diseases and malignancies. The pathological hallmark of the syndrome is aggressive proliferation of macrophages and histiocytes. Decreased NK cell activity results in increased T cell activation resulting production of large quantities of interferon gamma (IFN gamma), tumor necrosis factor alpha (TNF alpha) and granulocyte macrophage colony stimulating factor (GM-CSF). This causes sustained macrophage activation and tissue infiltration as well as production of interleukin 1 (IL1) and interleukin 6 (IL6).The resulting inflammatory reaction causes extensive damage and associated symptoms. Patients with HLH commonly present with high fever, anemia and splenomegaly. Minimal diagnostic parameters are a complete hemogram, liver function test, serum triglycerides and ferritin, coagulation profile including fibrinogen and bone marrow aspiration. Two highly sensitive diagnostic marker are an increased plasma concentration of the alpha chain of soluble IL2 receptor (CD25) and impaired NK cell activity. Hyperinflammation can be treated with steroid, Cyclosporine prevents T lymphocytes and immunoglobulin infusion helps to control the infection. Etoposide may be life saving specially in case of HLH with Ebstein Barr Viruses infection. The Histiocyte Society in 1994 developed a common treatment protocol (HLH-94). In January 2004 a revised HLH treatment protocol was opened entitled HLH-2004, which is based on HLH-94 with minor modifications. There is a high remission rate on the HLH-94 and HLH-2004 treatment protocols.

Eucalyptus microsatellites mined in silico: survey and evaluation.

Eucalyptus is an important short rotation pulpy woody plant, grown widely in the tropics. Recently, many genomic programmes are underway leading to the accumulation of voluminous genomic and expressed sequence tag sequences in public databases. These sequences can be utilized for analysis of simple sequence repeats (SSRs) and single nucleotide polymorphism (SNPs) available in the transcribed genes. In this study, in silico analysis of 15,285 sequences representing partial and full-length mRNA from Eucalyptus species for their use in developing SSRs or microsatellites were carried out. A total of 875 EST-SSRs were identified from 772 SSR containing ESTs. Motif size of 6 for dinucleotide and 5 for trinucleotide, tetranucleotide, and pentanucleotides were considered in locating the microsatellites. The average frequency of identified SSRs was 12.9%. The dinucleotide repeats were the most abundant among the dinucleotide, trinucleotide and tetranucleotide motifs and accounted for 50.9% of the Eucalyptus genome. Primer designing analysis showed that 571 sequences with SSRs had sufficient flanking regions for polymerase chain reaction (PCR) primer synthesis. Evaluation of the usefulness of the SSRs showed that EST-derived SSRs can generate polymorphic markers as all the primers showed allelic diversity among the 16 provenances of E. tereticornis.

Transverse testicular ectopia with persistent Muellerian duct syndrome.

A one-year-old boy was admitted with complaints of swelling in the left inguinoscrotal region and an empty right scrotum since birth. The inguinoscrotum contained two ovoid solid swellings one above the other. The swellings were testes like in feel, size and shape. The diagnosis was transverse testicular ectopia. The case was managed by surgery. Tissue from gonads, the tubular structures and the fallopian tubes were sent for histopathological examination for confirmation. This was a case of an otherwise normal male with transverse testicular ectopia with persistent Muellerian duct syndrome in the left inguinoscrotal hernial sac.

Improvement of dry matter digestibility of water hyacinth by solid state fermentation using white rot fungi.

Feeding value of water hyacinth biomass colonized by three species of white rot fungi during solid-state fermentation was investigated. All three organisms proved to be efficient degraders and enhanced dry matter digestibility. Loss of organic matter was maximum (23.6+/-0.1% dry wt) after 48 days by P. ostreatus. C. indica showed maximum cellulose degradation (18.5+/-0.1% dry wt) than other two fungi after 48 days of incubation. In all cases, an extensive removal of hemicellulose at the initial growth period and a delayed degradation of lignin were observed. Hemicellulolysis was maximum (46.3+/-0.1% dry wt) by C. indica, but delignification (14.2+/-0.2% dry wt) by P. sajor-caju after 48 days. The amount of reducing sugar in the degraded biomass decreased at early stages, but increased as degradation progressed in all three cases (maximum 1.1+/-0.05% dry wt after 48 days by C. indica). Soluble nitrogen content increased only during 16-32 days of incubation (highest 1.1+/-0.1% dry wt after 32 days by P. sajor-caju). Crude protein of the bioconverted biomass increased gradually up to 32 days but decreased thereafter (maximum 10.3+/-0.1% dry wt after 32 days by P. sajor - caju). Per cent change in in vitro dry matter digestibility of degraded substrates enhanced gradually after 8 days and reached maximum after 32 days but thereafter decreased (highest + 20.4+/-0.3% dry wt by P. sajor-caju). The results demonstrated the efficient degrading capacity of the test fungi and their potential use in conversion of water hyacinth biomass into mycoprotein-rich ruminant feed, more so by P. sajor-caju.

Can we identify acute severe viral lower respiratory tract infection clinically?

Two hundred children below five years of age hospitalized with a clinical diagnosis of acute severe lower respiratory tract infection were enrolled in the study. Nasopharyngeal (NP) aspirate was collected for viral isolation by centrifugation enhanced culture technique. Viruses were isolated from 89 NP aspirates. Clinical features of these 89 children were compared with 111 children whose NP aspirates were negative for viruses. There was significantly higher incidence of breathlessness and rhonchi in children whose nasopharyngeal aspirates yielded virus. Sensitivity,specificity, positive and negative predictive values of breathlessness for severe viral ALRTI were 98%, 10.8%, 46.8% and 85%, respectively. The values for rhonchi were 60%, 56.8%, 58.2%, and 74.1%, respectively. It is concluded that clinical features do not have desirable sensitivity and specificity for identification of ALRTI due to viral etiology.

Clinical profile and frequency of delta f508 mutation in Indian children with cystic fibrosis.

OBJECTIVE: To document clinical profile of cystic fibrosis (CF) in Indian children and the prevalence of delta F508 mutation in these patients. DESIGN: Observational study. Setting:Pediatric chest clinic in an urban tertiary care center in north India. PERIOD OF STUDY: July 1995 to June 2002. METHODS: Clinical features of 120 children diagnosed as CF by quantitative pilocarpine iontophoresis were recorded. A polymerase chain reaction based test for identification of delta F 508 mutation was performed on all children. RESULTS: Out of 3500 new cases registered in Pediatric Chest Clinic during this period 120, (3.5%) children were diagnosed as CF. Origin of parents of patients traced from almost all the States of north India. Family history suggestive of CF was present in 41 (34%) and consanguinity in 19 (61%) patients. Common clinical manifestations at the time of presentation included recurrent or persistent pneumonia in 118 (98%), failure to thrive in 108 (90%), malabsorption in 96 (80%), history of meconium ileus in 10 (8%), and rectal prolapse was present in 16 (13%). History of salt craving, salty taste on kissing and skin rashes was present in 5 patients each. 49(41%) patients were severely malnourished. Nasal polyposis was present in 5 (4%) patients. Examination of chest revealed evidence of hyperinflation in 100 (83%), kyphosis 20 (17%), crepitations 110 (92%), wheezing 40 (25%) and bronchial breathing in 20 (17%) patients. Average clinical CF scores were 51 (95%; CI 20-80). 48 (40%) patients had a CF score of LT40. Pseudomonas spp was cultured from respiratory secretions of 51 (42%), Staphylococcus spp in 18 (15%), Klebsiella spp in 8 (7%) and Hemophilus influenzae in 2 (2%) patients. Delta F508 mutation was positive in 45 chromosomes out of 240 tested. Patients originated from Pakistan had more frequency of delta F508 mutations. CONCLUSIONS: Cystic fibrosis does occur in Indian children; clinical features are classical. Diagnosis is often delayed and the disease is advanced in most patients at the time of diagnosis. Frequency of Delta F508 mutation is 19% i.e., less than that seen in Caucasian population. There is need to create awareness about occurrence of CF in Indian children.

Etiology of acute lower respiratory tract infection.

OBJECTIVE: To identify pathogens responsible for acute severe lower respiratory tract infection (ALRTI) in under five children by non-invasive methods. METHOD: 95 children hospitalized with acute severe lower respiratory tract infection were investigated for identification of viruses, bacteria, chlamydia or mycoplasma by nasopharyngeal aspirates, blood culture and serology. RESULT: Etiological agents could be identified in 94% of the patients. Viruses from NP aspirate could be isolated in 36 (38%), bacterial isolates from blood cultures in 15 (16%); mycoplasma was identified in 23 (24%) and chlamydia in 10 (11%) by serological tests; mixed infections were present in 8 (8%) patients. CONCLUSION: Noninvasive methods can be useful in identifying etiological agents in severe ALRTI.

An indigenously developed method for sweat collection and estimation of chloride for diagnosis of cystic fibrosis.

An indigenously developed method for sweat collection and titration method for estimation of chloride was validated. The mean difference in estimated chloride value from the known strength of saline in 50 samples was -1.04 +/- 4.13 mEq/L (95% CI: -0.07 to 2.28). The mean difference in the estimated chloride values between two observers when the test was performed on known strengths of saline solution was -2.5 +/- 4.24 mEq/L (95% CI: -3.67 to 1.33). The inter observer variability between two observers when the test was performed on sweat samples obtained from 50 individuals was -1.12 +/- 4.34 mEq/L (95% CI: -2.23 to 0.8 ). Sweat weight of more than 100 mg could be collected in first attempt in 602 of 757 (80%) patient with an average sweat weight of 230 mg. This inexpensive method of sweat collection and chloride estimation has acceptable accuracy and repeatability and can be used in resource poor setting for making a diagnosis of cystic fibrosis.

Risk factors for severe acute lower respiratory tract infection in under-five children.

BACKGROUND: Acute lower respiratory infection (ALRTI) is the leading cause of death in children below five years of age. Identification of modifiable risk factors of severe ALRTI may help in reducing the burden of disease. METHODS: A hospital based case control study was undertaken to determine risk factors associated with severe lower respiratory tract infection (LRTI) in under-five children. A case definition of severe ALRTI as given by World Health Organization (WHO) was used for cases. Healthy children attending Pediatrics out patient department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in pre-designed proforma. RESULTS: 512 children including 201 cases and 311 controls were enrolled in the study. On stepwise logistic regression analysis it was found that lack of breastfeeding (OR: 1.64; 95 percent CI: 1.23-2.17); upper respiratory infection in mother (OR: 6.53; 95 percent CI: 2.73-15.63); upper respiratory infection in siblings (OR: 24; 95 percent CI: 7.8-74.4); severe malnutrition (OR: 1.85; 95 percent CI: 1.14-3.0); cooking fuel other than liquid petroleum gas (OR: 2.5; 95 percent CI: 1.51-4.16); inappropriate immunization for age (OR: 2.85; 95 percent CI 1.59-5.0) and history of LRTI in the family (OR 5.15, 95 percent CI 3.0-8.8) were the significant contributors of ALRTI in children under five years. Sex of the child, age of the parents, education of the parents, number of children at home, anemia, inadequate caloric intake, type of housing were not documented to be significant risk factors of ALRTI. CONCLUSION: Lack of breast-feeding, upper respiratory infection in mother, upper respiratory infection in siblings, severe malnutrition, cooking fuel other than liquid petroleum gas, inappropriate immunization for age and history of LRTI in the family were the significant risk factors associated with ALRTI

Study on early intervention with ACE inhibitor in myocardical infarction and short term outcome.

The present study was carried out on 100 patients with acute myocardial infarction (AMI) being treated with angiotensin converting enzyme (ACE) inhibitor and another 80 patients with conventional treatment but without ACE inhibitor during the period from May 1, 1995 to August 7, 1996 in Medical College, Calcutta. Clinical and other laboratory investigations including echocardiographic parameters were noted and recorded meticulously within 24-48 hours after AMI and repeated at 4th week. The present study based on non-invasive methods other than haemodynamic methods has shown that the echocardiographic assessment of left ventricular functional parameters after 4 weeks of ACE inhibitor therapy (n = 100) were better in treated group in comparison to control group without ACE inhibitor (n = 80) and the difference was statistically significant at 99% level of confidence. Overall mortality was 4% in ACE inhibitor group and 8.75% in the control group. This short term study with early intervention with ACE inhibitor within 48 hours of AMI has shown statistically significant evidence of beneficial effect of ACE inhibitor in improving the ventricular functional parameters and also reducing short term mortality from cardiac cause within 4 weeks compared to the group not receiving ACE inhibitors.

Fraser-cryptophthalmos syndrome.

Fraser or Cryptophthalmos syndrome is a variable syndrome to the extent that cryptophthalmos might not be present in all cases. However, the main features are a "hidden eye", other craniofacial abnormalities, renal abnormalities, syndactyly and abnormal genitalia. It may be classified as isolated cryptophthalmos or cryptophthalmos sequence and cryptophthalmos syndrome. The cryptophthalmos syndrome has an autosomal recessive mode of inheritance. Isolated cryptophthalmos has been reported as an autosomal dominant trait. Prenatal diagnosis is possible using ultrasonography and fetoscopy. We report three cases of cryptophthalmos. One with renal agenesis had cryptophthalmos syndrome and the other two had isolated cryptophthalmos or cryptophthalmos sequence.

Infantile-onset leukoencephalopathy with discrepant mild clinical course.

Four children characterised by megalencephaly and cerebral leukoencephalopathy with infantile onset, defined on the basis of clinical and neuroimaging findings are reported. The course of the disease is characterised by stabilization of the macrocephaly and slow clinical deterioration. The CT scan findings include supratentorial diffuse hypodensities in the white matter and swelling. The characteristic MRI findings include the discrepant severity in comparison with the clinical picture, diffuse supratentorial white matter abnormalities with subcortical cysts. The basic defect of the disease is unknown. Considering the high rate of consanguinity among the parents and the presence of two affected sibs in one family, an autosomal recessive inheritance is assumed. We report four unrelated cases of this entity.