Associations between new and old anthropometric indices with type 2 diabetes mellitus and risk of metabolic complications: a cross-sectional analytical study / Associação de índices antropométricos novos e antigos com diabetes melito tipo 2 e risco de complicações metabólicas: um estudo analítico de corte transversal

Abstract Background Obesity can increase the risk of diabetes mellitus and complications associated with it. Objectives The aim of this study was to estimate the associations between new and old anthropometric indices and the risk of type 2 diabetes mellitus (T2DM) and its metabolic complications. Methods In this cross-sectional analytical study, 110 T2DM subjects and 110 healthy controls were selected by convenience sampling. Metabolic factors were evaluated including the atherogenic index of plasma (AIP), glycemic status, lipid profile, blood pressure, kidney indices, new anthropometric indices (abdominal volume index [AVI], body shape index [ABSI], lipid accumulation product [LAP], body adiposity index [BAI], and conicity index [CI]), and old anthropometric indices (weight, body mass index [BMI], and waist and hip circumference [WC and HC]). Results Significant positive correlations were observed between AVI, LAP, and BAI and fasting blood glucose and HbA1c in the T2DM group (p < 0.001 for all associations). The odds ratio (OR) for T2DM elevated significantly with increasing BMI (OR: 1.30, 95% CI: 1.20-1.42), LAP (OR: 1.20, 95% CI: 1.13-1.27), and BAI (OR: 1.32, 95% CI: 1.21-1.43). The indices AVI (OR: 1.90, 95% CI: 1.57-2.29), LAP (OR: 1.19, 95% CI: 1.13-1.27), BAI (OR: 1.19, 95% CI: 1.12-1.26), WC (OR: 1.29, 95% CI: 1.18, 1.42), and HC (OR: 1.07, 95% CI: 1.01, 1.14) significantly increased the risk of metabolic syndrome (MetS). Conclusions Associations were identified between obesity indices and diabetes. These indices could be used in clinical practice for evaluation and control of T2DM.

Resumo Contexto A obesidade pode aumentar o risco de diabetes melito e complicações associadas. Objetivos O objetivo deste estudo foi estimar a associação de índices antropométricos novos e antigos com o risco de diabetes melito tipo 2 (DM2) e suas complicações metabólicas. Métodos Neste estudo analítico transversal, 110 indivíduos com DM2 e 110 controles saudáveis foram selecionados por amostragem de conveniência. Foram avaliados os fatores metabólicos, incluindo índice aterogênico plasmático, estado glicêmico, perfil lipídico, pressão arterial, índices renais, índices antropométricos novos [índice de volume abdominal (AVI), índice de formato corporal (ABSI), produto de acumulação lipídica (LAP), índice de adiposidade corporal (BAI) e índice de conicidade (CI)] e índices antropométricos antigos [peso, índice de massa corporal (IMC), circunferência de cintura e quadril]. Resultados Foi observada uma correlação positiva significativa de AVI, LAP e BAI com glicemia de jejum e hemoglobina glicada no grupo DM2 (p para todos < 0,001). A odds ratio (OR) do grupo DM2 foi significativamente elevada com aumento de IMC [OR: 1,30, intervalo de confiança (IC) de 95%: 1,20-1,42], LAP (OR: 1,20, IC95%: 1,13-1,27) e BAI (OR: 1,32, IC95%: 1,21-1,43). Os índices AVI (OR: 1,90, IC95%: 1,57-2,29), LAP (OR: 1,19, IC95%: 1,13-1,27), BAI (OR: 1,19, IC95%: 1,12-1,26), WC (OR: 1,29, IC95%: 1,18-1,42) e HC (OR: 1,07, IC95%: 1,01-1,14) aumentaram significativamente o risco de síndrome metabólica. Conclusões Foi reconhecida uma associação entre índices de obesidade e diabetes. Esses índices podem ser usados na prática clínica para avaliação e controle do DM2.

Minimum Volume of LA Required to Surround Each of the Branches of the Axillary Brachial Plexus using Ultrasound Guided Technique

Introduction: The minimum volume of LA required toeffectively block the four main branches of the axillary brachialplexus is unknown. The main aim of the current study wasto determine the minimal volume of LA required to surroundeach branch of axillary brachial plexus and document its onsetand duration of sensory and motor effects.Material and methods: 20 patients with ASA I–II undergoinghand or forearm surgery were selected for this study. USG wasused to locate each of the 4 branches of axillary plexus. 1.5%of lignocaine with 1:200 000 of adrenaline was loaded into asyringe driver and deposited with a 22 G needle and injectioncommenced using the bolus function (600 ml h21).Results: The mean (95% of Confidence Interval) volumerequired for each nerve was: radial 3.32 (2.74–3.89) ml,median 2.65 (2.01–3.19) ml, ulnar 2.48 (2.04–2.93) ml, andmusculocutaneous 2.20 (1.86–2.54) ml. The mean (95% ofConfidence Interval) onset time for complete sensory blockwas: radial 21.5 (12.5–30.5) min, median 25.8 (17.5–34.0)min, ulnar 25.6 (16.8–34.4) min, and musculocutaneous 14.8(7.35– 23.2) min. The mean (95% of Confidence Interval) lastrecorded time with complete block was: radial 136.1 (104.6–158.7) min, median 143.7 (122.4–165.0) min, ulnar 182.2(157.1–207.2) min, and musculocutaneous 157.3 (130.8–183.9) min.Conclusions: We concluded that it is possible to deposit 2–4ml of local anaesthetic around each branch of axillary plexus.We also speculate that by increasing the amount of volumeof LA would produce anesthesia of quicker onset and withlonger.

Classical Closed Technique by Veress Needle Insertion Versus Direct Trocar Insertion in the Creation of Pneumoperitoneum in Various Laparoscopic Surgeries

Introduction: Laparoscopy has revolutionised Surgerywith its widespread acceptance as predominantly minimallyinvasive to intraabdominal surgical procedures. Creationof pneumoperitoneum is indispensable primary step ofthe procedure as it allows creation of operative field. Itcan be achieved by various techniques viz Classical openmethod as described by Hasson. The aim of the study wasto ascertain safety of direct trocar insertion in creation ofpneumoperitoneum in laparoscopic surgeries and adopt thesame as an alternative to veress technique.Material and methods: A total of 576 patients were includedin the study, Group A comprised of patients in whom wecreated pneumoperitoneum by classical veress needleinsertion and included 327 patients. Group B comprised of249 patients in whom we created pneumoperitoneum by directtrocar insertion method.Results: The mean age of patients was 47.54 years SD 11 witha male female ratio of 1:1.56. Laparoscopic cholecystectomy(52.08%) was most frequent followed by laparoscopicappendectomy (13.02%). Group A patients witnessed omentalemphysema (7.95%) as commonest complication followed bypreperitoneal insufflation(5.19%) while as the most commoncomplication in group B was omental emphysema (0.81%).Port site infection (4.28%) and subcutaneous emphysema(3.36%) predominated in group A and port site infection(1.2%) and seroma formation (1.2%) were common in groupB.Conclusion: There are many methods to createpneumoperitoneum. The closed technique modified to directtrocar insertion versus classical method by Veress werecompared in patients undergoing laparocopic proceduresat SMHS hospital for a period of one and a half year. Theresults are fascinating as the modified technique overshadowsits classical version in terms of feasibility, efficacy andconsumption of time.

Psychosocial and medical factors affecting treatment compliance in patients attending psychiatric hospital: a study from Kashmir.

Background: Compliance with medication is decisive for treatment of the psychiatric disorders and is necessary for determining the outcome and prognoses of psychiatric patients. While the causes of poor compliance are multifactorial, the psychiatrist should be aware of such factors and may be able to implement interventions to address those factors. The objective of study was to find out the various medical and social reasons affecting treatment Compliance among patients suffering from psychiatric disorders. Methods: A Cross-Sectional study from 2011 to 2012 was conducted in IMHANS (Institute of Mental Health and Neurosciences) Srinagar (J&K), a questionnaire was designed, and the questionnaire included questions on socio-demographic variables, psychiatric illnesses, and Medical and psycho-social affecting treatment compliance. A systematic selection method for choosing the respondents was opted, questionnaire was administered on 200 (n=200) patients who attended the Outpatient department during the period. Simple random sampling method was applied for selection of respondents, the first time visitors to OPD were exclude along with repetition of respondents. Results: Out of 200 respondents studied in the study 41.5 % were males and 58.5% were females. Maximum number of patients (31.5%) studied were in the age group below the 30 years. 3.5% of respondents were in the age group above 70 years. Out of total 200 respondents in the study 74 % of the respondents are in compliance with recommended medicine whereas non-compliance was found in the 26% of studied population. Complications (13.46%) ascending out by usage of psychiatric medicine can be attributed as one of the major case of treatment non-compliance in psychiatric patients, among the psychiatric patients. Accessibility of psychiatric medicine and Financial constrain was also one of the reasons behind the medicine non-compliance (7.69%). Patients with no insight to psychiatric disease also include a good percentage of (5.76 %) of medicine non- compliance. Conclusions: Non-compliance is a dominant factor which causes possibly causes readmission in psychiatric wards. Compliance in psychiatric patients in general could be enhanced and improved by adequate intervention via patient counselling and patient medicinal care and education.

Evaluation of enzyme linked immunosorbent assay (ELISA) for IgG in the diagnosis of human hydatid disease.

The aim of this study was to evaluate the role of ELISA for IgG antibodies against Echinococcus granulosus in detecting hydatid disease of liver and lung. The levels of IgG antibodies against Echinococcus granulosus were measured by indirect ELISA. A total of 32 patients were included in this study of which 20 had hydatid cysts in liver and 12 had in lung. Among 20 patients with hydatid cysts of liver, 18 had positive serology while 2 had negative serology. In patients having cysts in lung, 9 had positive serology while 3 had negative. The test showed 90% sensitivity in the diagnosis of hepatic cysts. However the sensitivity of this test was only 75% for pulmonary cysts. The overall diagnostic sensitivity of IgG ELISA in the diagnosis of both liver and lung hydatidosis was 84.37%. Conclusion: ELISA test is a sensitive test and can be used in the diagnosis of human hydatidosis.

Isolation of lactic acid bacteria under low temperature for the preparation of yogurt.

Objective: An investigation of isolation of Lactic acid bacteria was carried out under low temperature for the preparation of Yogurt by using various food supplements like carrot, ground-nut and tomato juices. Methods: Various samples of Cow milk, Skimmed milk were processed along with nutrients like Carrot, ground nut and tomato juices with Tryptone glucose yeast extract agar (TGYA) at different temperatures like 50C, 150C and 220C for the isolation of Lactic acid bacteria for the preparation of yogurt. The characteristic isolates were identified by using various biochemical tests and direct microscopy. Results: Lactic acid bacteria (LAB) dominated the microbial population of Yogurt, and were identified according to their morphological and physiological characteristics. Among these lactobacilli were frequently occurring organisms. The most abundant species were Lactobacillus delbrueckii subspecies Bulgaricus and Streptococcus thermophilus. The Lactic Streptococci was subjected to bio-chemical tests to identify the species. Based on the biochemical reactions the species was identified as Lactococcus Lactis, sub species di-acetylactis. Isolated culture of lactic Streptococci was found to grow at low temperature. When this was used as an inoculum to prepare yogurt at 50C, 150C and 220C curdling took place in 3days time. In order to reduce the setting time, nutrients in the form of carrot, ground-nut and tomato juices were added. The yogurt was found to set at 50C in 30hrs which is considered useful. Acidity of yogurt was found to be 0.53%- 0.55%. The yogurt was found to contain di-acetyl and quality of yogurt was good.

First reported case of reactive airway dysfunction syndrome in a laborer due to porcelain tile dust

Reactive airway dysfunction syndrome [RADS] is a type of non-immunologically mediated asthma-like disease. It usually occurs after a massive exposure to an irritating substance in the atmosphere in the form of smoke, fumes, gases, and vapor. Unlike bronchial asthma, there is no latency to the symptoms seen in RADS. A number of agents are known to cause RADS, but tile dust, as an etiological agent, has not been previously reported. We report a 45-year-old male laborer, who presented with an acute onset of cough, chest tightness, breathlessness, and audible wheeze after his first time exposure to porcelain tile dust within 5 hours of exposure. Lab tests, including, chest X-ray, electrocardiogram, air blood gas analysis, and serum IgE, were unremarkable. Spirometry showed a mild obstruction [forced expiratory volume in 1 second [FEV1]=72% of predicted], while the bronchodilator reversibility test was significant[14% increase in FEV1 above the baseline].Bronchial biopsy revealed a chronic inflammatory reaction with lymphocytic and plasma cell infiltration and more importantly a striking absence of eosinophils. To t he best of our knowledge, this is the first reported case of RADS as a result of exposure to tile dust [porcelain ceramics]

Glucose intolerance in relation to socioeconomic status and gender in population of Srinagar city

To assess the pattern of type -2 diabetes in different socioeconomic groups in the urban and peri-urban areas of Srinagar city. A detailed questionnaire on the Socioeconomic and Clinical background of the 1040 subjects was collected. After an overnight for blood fasting blood samples were drawn for determination of plasma glucose. Diagnosis of diabetes was based on the American Diabetes Association [ADA 2004]. The overall Prevalence of the diabetes in the study population was 6.05% which included 4.03% of known diabetic and 2.02% undiagnosed subjects. There was significant difference between the prevalence of type 2 diabetes in men and women [3.6%vs 8.3% respectively, P=0.0013]. Subjects belonging to higher socioeconomic status had greater prevalence of diabetes compared to lower 17.4% vs 3.2% [P<0.001][middle class [class II and Class III] versus lower class[Class IV]respectively]. Socioeconomic factors influence the occurrence of diabetes in this study population, with prevalence being more come in the middle class

Effects of Kamdhenu ark and active immunization by gonadotropin releasing hormone conjugate [GnRH-BSA] on gonadosomatic indices [GSI] and sperm parameters in male mus musculus

Active immunization against GnRH decreases the secretion of gonadotropins and causes cessation of gonadal function, thereby, inducing infertility. Based on the immunoenhancing activity of Kamdhenu ark [distilled cow urine], this study was performed to evaluate its effects on the gonadosomatic indices [GSI] and sperm parameters in male mice receiving a GnRH contraceptive vaccine. Sixty adult male mice of Parke's strain were divided into three groups of twenty. Group I served as the controls, while group II was immunized by GnRH-BSA conjugate [50/0.2/35 micro g/ml/g BW] by four intraperitoneal injections at different intervals on days 1, 30, 60 and 90. however, group III was supplemented daily by oral Kamdhenu ark [100 ppm] along with GnRH-BSA immunizations. The animals were sacrificed after 30, 60, 90 and 120 days and their testis and epididymis were dissected out weighed and semen analysis was performed. GSI values, sperm motility, sperm count and sperm morphology in male Mus musculus were decreased significantly in all the experimental groups as compared to the control group [p< 0.01]. Kamdhenu ark significantly enhanced the effect of GnRH vaccine on the aforesaid parameters especially in 90 and 120 days treated groups [p<0.05]. The changes witnessed in sperm parameters suggested that the GnRH-BSA immunization suppressed the activities of gonadotropins and testosterone directly through hypthalamo- hypophysial-gonadal axis and indirectly by acting on the testes which may modulate the sperm morphology, sperm count and motility. However, Kamdhenu ark seems to have enhanced these effects because of its immune-modulatory properties too

Effects of gonadotropin releasing hormone conjugate immunization and bioenhancing role of Kamdhenu ark on estrous cycle, serum estradiol and progesterone levels in female Mus musculus

Active immunization with gonadotropin releasing hormone conjugate [GnRH-BSA] manipulates the fertility axis and thus alters the reproductive cyclicity, serum estradiol and progesterone levels. While the application of Kamdhenu ark increases the efficacy of GnRH-BSA. This experimental investigation is aimed to evaluate the modulatory effects on estrous cycle, serum estradiol and progesterone levels in female mice after Kamdhenu ark and GnRH-BSA immunization. Sixty sexually mature female mice were divided into three groups of twenty each. Group I served as control, while group II was immunized with GnRH-BSA conjugate [50 micro g/animal] for 120 days. However, group III was supplemented with Kamdhenu ark [100 ppm] orally along with GnRH-BSA conjugate immunizations and their vaginal estrous cyclicity, serum estradiol and progesterone levels were estimated after 30, 60, 90 and 120 days of intervals. GnRH-BSA immunized females showed regular estrous cycle initially but after 13[th] day animals started showing irregular and prolonged estrous cycle with a complete diestrus stage after 65[th] day onwards. In connection of this, GnRH-BSA + Kamdhenu ark supplemented animals also showed regular cyclicity initially but later they showed more interrupted cycle with complete diestrus stage after 55[th] day. Besides this, the serum estradiol and progesterone levels lowered significantly in all the experimental groups as compared to control animals. The more severe decrease in hormonal levels was noticed in later part of the experiment especially in the group supplemented with Kamdhenu ark along with GnRH-BSA immunizations. All these observations suggest that the GnRH-BSA conjugate has a deleterious effect on the reproductive hormones and estrous cycle of female mice; and Kamdhenu ark acts as a bioenhancer in immunization efficacy to modulate these effects

Association of Beta-catenin gene mutations and human papillomavirus in Carcinoma of Esophagus in a high-risk population of India

Background: Esophageal cancer [EC] is the sixth leading cause of death from cancer. In high-risk regions, squamous cell carcinoma is the most common type of EC, and its etiology remains poorly understood. It shows uneven geographical distribution in its occurrence, reflecting the influence of local environmental conditions, lifestyle and genetic predisposition in the development of the cancer. Kashmir, in the north of India, has been described as a high-risk area for esophageal squamous cell carcinoma [ESCC]. In the present investigation an attempt was made to study the role of -catenin mutations and human papillomavirus in 62 ESCC patients from Kashmir

Methods: The hot spot mutation region of -catenin exon 3 was evaluated in matched tumor and normal tissues using a combination of PCR-SSCP and direct sequencing. We used two different sets of consensus primers viz., GP5+ and GP6+; PGMY09 and PGMY11 in conjunction with reverse line blot assay to screen for human papillomavirus[HPV]

Results: None of the tumors showed the presence of commonly reported mutations in -catenin. In view of the fact that HPV has been linked to pathogenesis of EC, we screened all the tumor and control specimens for the presence of HPV and we didn't detect HPV in any of the matched tumor and control specimens in contrast to the positive controls we used

Conclusion: In conclusion our results suggest that squamous cell carcinoma of esophagus in Kashmir may arise independent of oncogenic Beta-catenin mutations and HPV is unlikely to be an etiologic factor for ESCC in this region

association of beta-catenin gene mutations and human papillomavirus in carcinoma of esophagus in a high-risk population of India

Esophageai cancer [EC] is the sixth leading cause of death from cancer. In high-risk regions, squamous cell carcinoma is the most common type of EC, and its etiology remains poorly understood. It shows uneven geographical distribution in its occurrence, reflecting the influence of local environmental conditions, lifestyle and genetic predisposition in the development of the cancer. Kashmir, in the north of India, has been described as a high-risk area for esophageal squamous cell carcinoma [ESCC]. In the present investigation an attempt was made to study the role of p-catenin mutations and human papillomavirus in 62 ESCC patients from Kashmir. The hot spot mutation region of p-catenin exon 3 was evaluated in matched tumor and normal tissues using a combination of PCR-SSCP and direct sequencing. We used two different sets of consensus primers viz., GP5+ and GP6+; PGMY09 and PGMY11 in conjunction with reverse line blot assay to screen for human papillomavirus [HPV]. None of the tumors showed the presence of commonly reported mutations in p-catenin. In view of the fact that HPV has been linked to pathogenesis of EC, we screened all the tumor and control specimens for the presence of HPV and we didn't detect HPV in any of the matched tumor and control specimens in contrast to the positive controls we used. In conclusion our results suggest that squamous cell carcinoma of esophagus in Kashmir may arise independent of oncogenic p-catenin mutations and HPV is unlikely to be an etiologic factor for ESCC in this region