Comparative evaluation of amisulpride and escitalopram on Hamilton anxiety rating scale among depression patients in a tertiary care teaching hospital in Nepal.

Background: Depression is an important global public health problem and is a major cause of disability and premature death. The present study was conducted to compare effi cacy and safety of amisulpride and escitalopram on Hamilton anxiety rating scale (HAM-A) among depression patients in a tertiary care teaching hospital in Nepal. Methods: The study was conducted in patients for 1-year in the Department of Neuropsychiatry, Nepalgunj Medical College and Teaching Hospital. A total of 117 depression patients were divided into two groups. Group I (58 patients) received amisulpride tablet at a dose of 50 mg/day and Group II (59 patients) were given escitalopram at a dose of 10 mg/day. The patients were required to follow-up at 4, 8 and 15 weeks. The effi cacy of the drugs was calculated by HAM-A. Adverse drug reactions (ADRs) were monitored at every follow-up. Appropriate statistical tools using Graphpad instat 3.0 were used for analysis p<0.05 was considered signifi cant. Results: HAM-A score in group receiving amisulpride at 0 and 15 weeks was 19.83±0.33 and 8.17±0.32 (p<0.0001). HAM-A score in group receiving escitalopram at 0 and 15 weeks was 20.76±0.28 and 8.98±0.24 (p<0.0001). Gastrointestinal disturbances, sexual disturbances, amenorrhea, lactation, agitation, and insomnia were the commonly encountered ADRs. Conclusion: Both amisulpride and escitalopram were highly effective in the treatment of anxiety in depression patients during the study period. Further, more clinical studies with longer follow-up duration are needed to substantiate the therapeutic effects of amisulpride.

Breast feeding and insulin levels in low birth weight neonates: A randomized study.

Objective. To evaluate the influence of early infancy feeding practices on fasting insulin levels, as marker of insulin resistance, in low birthweight neonates. Methods. Eighty successive low birth weight (<2.5 kg) neonates <10 days of age born at >38 wk of gestation at this tertiary care centre, were successively invited for participation in the study; parents of 52 (65%) consented to participate. Group 1 children (n=26) were randomized to receive only breast feeding and Group 2 (n=26) received fortified breast feeding with a commercially available human milk fortifier. Routine anthropometry and evaluation of health status was performed. The babies were followed-up every 15 day up to three months. 4-hour fasting glucose and insulin levels were measured at baseline and at 3 month. Statistical analyses were performed using t-test and Mann-Whitney test. Results. In excusively breast-fed Group 1 neonates vs Group 2 the mean birthweight was similar (1.99+0.23 vs 1.87+0.30 kg). There was no difference in body length, head circumference and chest circumference. Mean hemoglobin levels, fasting glucose (63.9+9.8 vs 64.3+8.0 mg/dl) and fasting insulin levels (1.44+1.19 vs 1.73+1.38 μU/ml), were also similar. At three month follow-up in Group 1 children receiving exclusive breast feeding, there was significantly lower weight as compared to Group 2 (3.40+0.3 vs 4.75+0.5 kg, p<0.01). This was associated with significantly lower fasting glucose (79.0+9.4 vs 85.6+8.4 mg/dl) and fasting insulin levels (6.95+4.27 vs 15.73+3.29 μU/ml) (p<0.001).The difference persisted even after adjustment for weight gain in Group 2 (weight adjusted insulin 11.26+3.3 μU/ml; p<0.001). Conclusions. Low birthweight neonates fed fortified breast milk had greater fasting insulin levels compared to those with exclusive breast feeding, at three month of age. The difference persisted after adjustment for excessive gain in fortified milk fed neonates and, suggests adverse glucometabolic programming.

Trends in prevalence of coronary risk factors in an urban Indian population: Jaipur Heart Watch-4.

BACKGROUND: To determine prevalence of multiple coronary risk factors in a North Indian Punjabi community and to compare these with previous population based studies in the same city in North India we performed an epidemiological study. METHODS: A community-based epidemiological study that focused on lifestyle determinants of obesity and its correlates in migrants from Punjab was performed at a single location in Jaipur. A house-to-house enumeration was performed to enroll all adults>or=20 years age in the locality who were then invited for participation in the study. Of the 1400 eligible subjects, 1127 participated (response rate 80.5%, men 556, women 571). Risk factor measurements included smoking or tobacco use, body-mass index (BMI), waist:hip ratio (WHR) and body fat, and in 644 (56.6%) subjects (men 340, women 304) blood examination for fasting blood glucose and lipids. Coronary risk factors were determined using pre-specified criteria. RESULTS: There was a significant prevalence of risk factors in both men and women respectively with smoking or tobacco use in 209 (37.6%) and 12 (2.2%), obesity (BMI>or=25 kg/m2) in 303 (54.5%) and 350 (61.3%), truncal obesity (high WHR) in 339 (61.0%) and 310 (54.30%), hypertension in 322 (57.9%) and 279 (48.9%), high total cholesterol>or=200 mg/dl in 111 (32.6%) and 120 (39.5%), low HDL cholesterol<40 mg/dl in 103 (30.3%) and 83 (27.3%), high triglycerides>or=150 mg/dl in 146 (42.9%) and 132 (43.4%), metabolic syndrome in 166 (48.8%) and 137 (45.1%), and diabetes in 88 (25.9%) and 64 (21.1%) subjects. In both men and women there was a significant age-associated escalation in obesity, central obesity, hypertension, high cholesterol and diabetes prevalence (Mantel-Haenszel chi2 for trend p<0.05). Logistic regression analyses revealed that obesity and truncal obesity were major determinants of multiple risk factors such as hypertension, hypercholesterolemia, metabolic syndrome and diabetes (age-adjusted odds ratios p<0.01). Comparison with previous population-based risk factor studies from the same city in years 1995 and 2002 revealed that risk factors were significantly greater in the present group. Age-stratified differences revealed that obesity at younger age was more frequent in the present cohort. CONCLUSIONS: There is a significant prevalence of multiple cardiovascular risk factors in this population group. Obesity is a major determinant of multiple risk factors and appears at a younger age compared to other studies in the same location.

Low birth weight and insulin resistance in mid and late childhood.

OBJECTIVE: Low birth weight is associated with adult insulin resistance and diabetes. We conducted this study to correlate low birth weight with insulin resistance in mid and late childhood. METHODS: Children whose birth weight records were available were successively enrolled from middle and low socioeconomic status urban schools in western India. 600 children in age groups 5-16 years were screened for availability of recorded birth weight in six schools. Detailed birth records were available for 158 children born full term. Parents of 134 (84.8%) agreed to participate in the study after informed consent. These children were evaluated for various anthropometric indices and fasting blood was obtained for determination of glucose and insulin levels. Insulin resistance was determined using homeostasis model assessment (HOMA) and HOMA-2 formula. Comparative, univariate and multivariate statistical analyses were performed. RESULTS: The mean age of the children was 10.0 +/- 2.4 years. Maternal diabetes was present in 3 (2.2%). Mean weight at birth was 2.84 +/- 0.61 kg and low birth weight (<2.5 kg) was in 49 children (36.6%). There was no significant statistical difference in current height, weight, body mass index, waist, hip, waist hip ratio, mid upper arm circumference, and systolic and diastolic blood pressure in children born with low or normal birth weight (P >0.10). In low birth weight as compared to normal birthweight children mean fasting blood glucose (80.1 +/- 16.1 vs. 70.1 +/- 14.8 mg/dL; P = 0.042), median (interquartile range) fasting insulin levels (10. 18, 6.08-18.54 vs. 2.12, 0.02-7.45 microU/mL; Mann Whitney U test, p<0.0001), and HOMA-derived insulin resistance (1.88, 1.06-4.52, vs. 0.35, 0.02-1.52, P < 0.0001) were significantly greater. There was a significant negative correlation of birth weight with fasting insulin levels after multifactorial adjustments (partial correlation coefficient r = -0.436, P <0.001). Multivariate conditional logistic regression analysis revealed that birthweight was significant determinant of fasting insulin levels after adjusting for age, gender, body mass index, waist and waist hip ratio (odds ratio 3.82, 95% confidence intervals 1.16-12.63, P = 0.028). CONCLUSIONS: Children born with low birth weight have significantly greater fasting glucose, fasting insulin levels and insulin resistance at mid and late childhood.

High prevalence of multiple coronary risk factors in Punjabi Bhatia community: Jaipur Heart Watch-3.

BACKGROUND: Studies among emigrant Indian populations have shown a high prevalence of obesity and many coronary risk factors in Bhatia community. To determine the prevalence of risk factors in this community within India we performed an epidemiological study. METHODS AND RESULTS: An ethnic-group sample survey to determine prevalence of cardiovascular risk factors was performed using community registers for enrollment. Methodology used was similar to Jaipur Heart Watch studies performed in 1995 and 2002. We invited 600 randomly selected subjects listed in Punjabi Bhatia community registers and could examine 458 (76.7%) persons (men 226, women 232). Evaluation for coronary risk factors, anthropometric measurements, blood pressure, electrocardiogram, fasting blood glucose and serum lipids was performed using standard definitions. Mean age was 43.2 +/- 14.6 years in men and 44.7 +/- 15.3 years in women. In both men and women there was a high prevalence of family history of coronary heart disease in 45 (19.9%) and 50 (21.6%), family history of diabetes in 96 (42.5%) and 77 (33.2%), sedentary habits in 82 (36.3%) and 73 (31.5%), smoking or tobacco use in 59 (26.1%) and 4 (1.7%), overweight or obesity (body mass index > or = 25 kg/m2) in 123 (54.0%) and 161 (69.4%), severe obesity (body mass index >30 kg/m2) in 47 (20.8%) and 75 (32.3%), truncal obesity (waist-hip ratio: men >0.9, women >0.8) in 175 (77.4%) and 186 (80.2%), increased waist (waist size: men >102 cm, women >88 cm) in 78 (34.5%) and 129 (55.6%), hypertension (blood pressure > or = 140/90 mmHg) in 116 (51.3%) and 120 (51.3%), diabetes in 40 (17.7%) and 33 (14.2%), hypercholesterolemia (total cholesterol > or = 200 mg/dl) in 75 (33.2%) and 67 (28.9%), high triglycerides in 55 (24.3%) and 34 (14.7%), low high-density lipoprotein cholesterol in 169 (74.8%) and 155 (66.8%), and the metabolic syndrome (defined by American National Cholesterol Education Program) in 84 (36.2%) and 111 (47.8%) respectively. Body mass index correlated significantly with (age-adjusted r2 value--men, women) waist diameter (0.52, 0.12), waist-hip ratio (0.21, 0.10), truncal obesity (0.54, 0.60), systolic blood pressure (0.19, 0.16), diastolic blood pressure (0.12, 0.16), hypertension (0.19, 0.31), and metabolic syndrome (0.28, 0.44) (p<0.05). There was a significant linear relationship of body mass index with the prevalence of hypertension, hypercholesterolemia, diabetes (women), and the metabolic syndrome (chi2 for trend p<0.05). Prevalence of these risk factors was the lowest in subjects with body mass index <20 kg/m2. A multivariate ordinal logistic regression analysis revealed that obesity was independently associated with multiple risk factors characterized by metabolic syndrome after adjustment for age, hypertension, and diabetes in both men (odds ratio 2.45, 95% confidence intervals 1.69, 3.57) as well as in women (odds ratio 2.93, 95% confidence intervals 1.86, 4.61) (p<0.01). CONCLUSIONS: There is a high prevalence of obesity, abdominal obesity, hypertension, diabetes, lipid abnormalities and the metabolic syndrome in this community that is significantly greater than reported studies in Jaipur and urban populations elsewhere in India. Obesity correlates strongly with multiple coronary risk factors of which it is an important determinant.

Prevalence of coronary heart disease and risk factors in an urban Indian population: Jaipur Heart Watch-2.

BACKGROUND: The prevalence of risk factors for coronary heart disease has been inadequately studied in India. A repeat cross-sectional survey was carried out to evaluate the changes in the major coronary risk factors in the urban population of Jaipur previously studied in the early 1990s. METHODS AND RESULTS: Randomly selected adults > or =20 years of age were studied using stratified sampling. The target study sample was 1800 with a population proportionate gender distribution (males 960, females 840). Coronary risk factors, anthropometric variables, blood pressure, ECG, fasting blood glucose and lipids were evaluated. A total of 1123 subjects (62.4%) (males 550, females 573) were examined. Fasting blood samples were available in 523 males and 559 females. Overall coronary heart diesase prevalence, diagnosed by history or ECG changes, was found in 34 males (6.18%) and 58 females (10.12%). Risk factor prevalence showed that smoking/tobacco use was present in 201 males (36.5%) and 67 females (11.7%). Physical inactivity, either work-related or leisure time, was seen in 157 males (28.5%) and 130 females (22.7%). Hypertension (> or =140 and/or 90 mmHg) was present in 200 males (36.4%) and 215 females (37.5%). Diabetes diagnosed by history or fasting glucose > or =126 mg/dl was found in 72 males (13.1%) and 65 females (11.3%). Obesity, body mass index > or =27 kg/m2 was present in 135 males (24.5%) and 173 females (30.2%), while truncal obesity (waist:hip >0.9 males, >0.8 females) was found in 316 males (57.4%) and 392 females (68.4%). The most common dyslipidemia in both males and females was low HDL-cholesterol (<40 mg/dl: males 54.9%, females 54.2%). High total cholesterol levels of > or =200 mg/dl (males 37.4%, females 4.1%), high LDL-cholesterol levels of > or =130 mg/dl (males 37.0%, females 45.8%) and high levels of triglycerides > or = 150 mg/dl (males 32.3%, females 28.6%) were also seen in a significant number. Hypertension, obesity, truncal obesity, diabetes and dyslipidemias increased significantly with age in both males and females (Mantel-Haenzel chi2 for trend, p<0.05). CONCLUSIONS: There is a high prevalence of standard coronary risk factors--smoking, physical inactivity, hypertension, hypercholesterolemia, diabetes and obesity--as well as factors peculiar to south Asians--truncal obesity, low HDL-cholesterol and high triglycerides--in this urban Indian population. As compared to a previous study in the early 1900s in a similar population, there is a significant increase in the number of people with obesity, diabetes and dyslipidemias.