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Background: An elevated cardiovascular risk has been demonstrated in middle-aged individuals with onset of hair greying before the age of 30 years. Increased serum levels of pro-inflammatory cytokines, interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-?), indicate an ongoing state of chronic inflammation that is correlated with cardiovascular risk but have not been studied earlier in patients with early onset of hair greying. Aim/Objective: To study various cardiovascular risk markers including pro-inflammatory cytokines interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-?) in patients with premature canities. Methods: This was a hospital-based case-control study of 40 patients with premature canities (age between 19 and 25 years; >5 grey hair) and an equal number of age and gender-matched healthy controls. The blood pressure, pulse rate and body mass index were recorded, and investigations including fasting blood sugar, serum insulin, fasting lipid profile, high sensitivity c-reactive protein (hs-CRP), IL-6 and TNF-? were performed. The homeostatic model assessment of insulin resistance (HOMA-IR) was calculated for all the participants. Results: The mean blood pressure, fasting blood sugar, serum insulin, hs-CRP and HOMA-IR were all significantly elevated in patients with premature canities and the serum HDL levels were significantly lower. A greater number of patients with premature canities had significantly elevated IL-6 as compared with the controls. Limitations: The sample size was small. A subjective scale was used for grading the severity of premature canities. Trichoscopic evaluation of severity of greying or modified phototrichogram could not be used in this study. Conclusion: Abnormalities in cardiovascular risk markers were found in patients with premature canities. Screening and counselling of patients with premature greying of hair is recommended in order to prevent future cardiovascular disease.
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Background: There is an increasing prevalence of coronary artery disease (CAD) in younger individuals. Lipid biomarkers such as lipoprotein-a (Lp-a), Apo A1, Apo B and Paraoxonase-1 (PON1) serve as important risk predictors for development of CAD. There is little evidence regarding the role of lipid biomarkers and their genetic polymorphisms in young (<50 years) ST-segment elevation myocardial infarction (STEMI) patients. Methods: This study included 110 young (18e50 years) STEMI patients and 110 healthy controls. Serum levels of Apo A1, Apo B, Paraoxonase-1 (PON-1) and Lipoprotein-associated phospholipase A2 (Lp-PLA2) were estimated for both patients as well as controls. Additionally, genetic polymorphisms in the Apo A1 (75G/A) and the PON1 (Q192R) genes were evaluated. Results: Serum levels of apo B (101.31 ± 27.58 vs 75.31 ± 18.77 mg/dl; p < 0.0001), Lp(a) [87.56 ± 74.28 vs 25.81 ± 24.66 mg/dl, p < 0.0001] and Lp-PLA2 [5.97 ± 1.39 vs 3.49 ± 1.27 ng/mL, p < 0.0001] were significantly higher in patients as compared to controls. Serum levels of Apo A1 [44.76 ± 35.65 vs 95.97 ± 29.89; p < 0.0001] and PON1 [2.63 ± 1.5 vs 3.87 ± 1.47 ng/mL, p < 0.0001] were significantly lower in cases as compared with controls. Additionally, patients with genetic polymorphisms in the Apo A1 (75G/A) and the PON1 (Q192R) gene had an increased risk of STEMI. Conclusion: Lipid biomarkers such as Apo A1, Apo B and PON1 and their genetic polymorphism are associated with the susceptibility for STEMI in young individuals.
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Background: Genetic polymorphism in MMPs are associated with multiple adverse CV events. There is little evidence regarding role of MMPs and their genetic polymorphisms in young (<50 years) STsegment elevation myocardial infarction (STEMI) patients. Methods: This study included 100 young (18e50 years) STEMI patients and 100 healthy controls. Serum levels of MMP-3, MMP-9 and TIMP were estimated for both patients as well as controls. Additionally, genetic polymorphisms in the MMP-9 gene (_x0001_1562 C/T and R279Q) & MMP-3 gene (5A/6A-1612) was evaluated. All these patients were followed up for one year and major adverse cardiac events (MACE) were determined. Results: Serum levels of MMP-3 (128.16 ± 115.81 vs 102.3 ± 57.28 ng/mL; P ¼ 0.04), MMP-9 (469.63 ± 238.4 vs 188.88 ± 94.08 pg/mL; P < 0.0001) and TIMP (5.84 ± 1.93 vs 2.28 ± 1.42 ng/mL; P < 0.0001) were significantly higher in patients as compared to controls. Additionally, patients with genetic polymorphisms in the MMP genes (5A/5A, 6A/6A and the AG genotypes) had an increased risk of STEMI. Patients with MACE had significantly higher levels of MMP-9 (581.73 ± 260.93 vs 438.01 ± 223.38 pg/mL; P ¼ 0.012). A cutoff value of 375.5 pg/mL of MMP-9 was best able to discriminate patients with STEMI and MACE with sensitivity of 77.3% and specificity of 57%. Conclusion: Novel biomarkers such as MMP-3, MMP-9 and TIMP and their genetic polymorphism are associated with the susceptibility for STEMI in young individuals. Higher MMP-9 levels in STEMI patients with MACE suggests its potential role in predicting cardiac remodeling and left ventricular dysfunction
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Purpose: To evaluate and compare endothelial cell changes in phacoemulsification and manual small- incision cataract surgery (MSICS) in patients with uncomplicated senile cataracts. Methods: This was a prospective, tertiary care hospital-based, randomized, double-blinded interventional study. In total, 152 patients with an uncomplicated senile cataract of nuclear grade III and above were recruited. Exclusion criteria included patients with preoperative endothelial cell density (ECD) less than 1500 cells/mm3, a history of previous ocular surgery, any other coexisting ocular disease, and intraoperative or postoperative surgical complications. Preoperative and postoperative values of ECD and central corneal thickness (CCT) were measured, analyzed, and correlated with various factors. Results: Patients were randomized into two interventional groups-MSICS and phacoemulsification. Factors associated with significant drop in postoperative ECD following phacoemulsification were patients with advanced age (P = 0.01), higher grades of cataract (P = 0.01), and longer effective phacoemulsification time (P = 0.007). Shallow anterior chamber depth (ACD) was strongly associated with greater ECD loss in both groups (P < 0.0001). A threshold value of 2.86 mm of ACD was defined for minimal endothelial cell loss following phacoemulsification. CCT was observed to slightly increase postoperatively in both groups but was insignificant (P > 0.05). Conclusion: Both MSICS and phacoemulsification have similar postoperative visual outcomes. An increase in postoperative CCT is insignificant following surgery. Greater postoperative ECD loss is associated with phacoemulsification with advanced age, hard nuclear cataracts, and longer effective phacoemulsification time. ACD can be used as an essential parameter preoperatively to determine the choice of surgical technique between MSICS and phacoemulsification
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Background: Induction of labor is indicated when the continuation of pregnancy poses risk to the mother or fetus. A variety of mechanical and pharmacologic methods are available but the best method of labor induction still remains unknown, study aimed at comparing the efficacy and safety among the two agents: transcervical Foley’s balloon catheter (FBC) and intravaginal slow release Dinoprostone E2 insert (DVI) with dinoprostone gel as control.Methods: A total of 174 patients were randomized into three groups of 58 each (Group A: dinoprostone 10 mg slow release intravaginal insert, Group B: transcervical Foley’s 16 French catheters, and Group C as control: 0.5 mg intracervical Dinoprostone gel. The safety and efficacy was compared among the groups. A p value of < 0.05 was considered statistically significant.Results: The mean insertion to active labor time (in hours) was significantly lower in Group A as compared to Group B (5.88±3.06 versus 13.56±2.8, p < 0.0001). Meantime of insertion to delivery (in hours) was significantly lower in Group A as compared to Group B (10.91±5.24 versus 21.17±2.99, p < 0.0001). The requirement of oxytocin for induction and augmentation in Group A was significantly lower as compared to Group B. Majority of the patients had normal vaginal delivery (NVD) in all the three groups. Regarding safety profile we found that slow-release DVI had more incidence of uterine tachysystole, but none of the cases had any fetal heart rate abnormality. Maternal fever was more in the FBC group, however, neonatal outcomes were comparable in both groups.Conclusions: The study concludes that slow release DVI is better in terms of efficacy as compared to transcervical FBC for induction of labor as assessed by improvement in Bishop score, insertion to active labor time and insertion to delivery time and comparable in terms of safety profile.
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Background: Adequate levels of physical activity combined with a balanced diet are two essential components of healthy lifestyle. Healthy eating and physical activity habits formed during childhood can persist into adulthood and prevent or delay premature onset of a number of chronic diseases.Methods: Present cross-sectional study was carried out using a questionnaire-based interview. It was conducted among school going children of age 8 years to 18 years. A total of 318 students were included in the study by means of total enumeration from class 2nd to class 12th of a selected school of field practice area conducted from July 2019 to September 2019.Results: The total of 318 students participated in the study. Majority of the respondents were involved in Moderate to vigorous physical activity (40.3%). Moreover, majority were found to be normal on the basis of stunting, wasting and body mass index for age 80.2%, 79.2%, 64.4% respectively.Conclusions: Physical activity level was found to be low as the age of children advanced. In female students the level of physical activity was low to moderate as compared to male students. Solutions to improve physical activity and nutritional status in children need to be incorporated for Indian schools’ curricula.
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Accurate estimation of the post-mortem interval is an important research topic in Forensic Medicine. But unfortunately all methods till now in use to determine the time of death are to a degree unreliable. A vitreous Biochemical change, in the post-mortem period has been researched for many years, but till date it has not been practically used. Various authors have found the co- relation of vitreous humour Na+, K+ & Ca²+ concentration, with increasing post-mortem interval. Some authors have used flame photometry method, while others have used Beckman coulter analyser method. Some authors have found changes in Vitreous Na+, K+ & Ca²+ concentration, between the two eyes of the study subjects and gender variation was also noticed. But still various lacunae exist in the present knowledge because of which estimation of post-mortem interval from vitreous biochemistry is not being practically used till date. So this topic needs further research to bring it in to routine use.
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BACKGROUND: Determining the levels of lipids and lipoprotein fractions is important in assessing the risk of coronary artery disease. The levels of total cholesterol, triglycerides and high-density lipoproteins are determined directly by enzymatic assays. In the case of low-density lipoproteins and very-low-density lipoproteins, Friedewald's formula has been in use since 1972. According to the formula, the level of very-low-density lipoprotein is equal to that of triglycerides divided by five, while that of low-density lipoprotein cholesterol is equal to the total cholesterol level minus the concentrations of high-density and very-low-density lipoproteins. The determination of low-density lipoprotein by this equation involves three independent lipid analyses, each of which may introduce errors. Besides, other lipoproteins, like intermediate-density lipoproteins and chylomicrons, are not accounted for. This study was done to compare the values of low-density and very-low-density lipoproteins by Friedewald's formula and to determine the values of high-density and low-density lipoproteins by homogenous assays with electrophoretic separation of lipoproteins. METHODS AND RESULTS: Sixty adult patients with triglyceride levels of less than 400 mg/dL were evaluated. The level of low-density lipoprotein was measured enzymatically, using cholesterol esterase, after selective micellary solubilization of low-density lipoprotein cholesterol by a non-ionic detergent. High-density lipoprotein cholesterol was estimated similarly, after binding anti-human ss-lipoprotein antibody to low-density lipoprotein, very-low-density lipoprotein and chylomicrons. Electrophoretic separation of serum lipoproteins was done on agarose gel, and the bands scanned by a densitometer using a 570-nm filter. The values of low-density and very-low-density lipoproteins were also calculated using Friedewald's formula, following the spectrophotometric assay of serum cholesterol and triglycerides. Using the paired t-test, we found that the values of low-density lipoprotein as calculated by Friedewald's formula were significantly different from those determined by direct assays (p < 0.001) and electrophoresis (p < 0.001). Further, the values determined by direct assay and electrophoresis did not differ significantly (p = 0.53). The high-density lipoprotein cholesterol values as determined by direct assay and electrophoresis differed significantly (p < 0.001) from each other. The level of very-low-density lipoprotein as calculated by Friedewald's formula was significantly different from that estimated by electrophoresis (p < 0.001). CONCLUSION: Though Friedewald's equation is widely used in the case of triglyceride levels below 400 mg/dL, the values arrived at are erroneous if there are alterations in intermediate-density lipoproteins, as reported in diabetes mellitus, chronic renal failure, coronary heart disease and certain other disorders. This study shows that even at low triglyceride levels, the calculated values of various lipoproteins differ from those measured by direct spectrophotometric and electrophoretic assays.