Angiotensin-converting enzyme gene I/D polymorphism increases the susceptibility to hypertension and additive diseases: A study on North Indian patients.

Angiotensin-converting enzyme (ACE) is the key enzyme of the renin angiotensin system (RAS) which maintains the blood pressure homeostasis in our body. The association of the ACE insertion/deletion (I/D) polymorphism with essential hypertension has been demonstrated by many studies. The purpose of the present study is to investigate the association of the insertion/deletion polymorphism of the ACE gene with hypertension and additive diseases in North Indian population. In total, 222 hypertensive and 218 normotensive adults participated in this hospital-based study. Anthropometric measures, lipids profiles, blood glucose, and blood pressure (BP) measures were collected from participants. ACE I/D polymorphism was determined by using insertion-specific amplification. The mean ages of study groups were 50.35 ± 12.40 and 47.32 ± 11.94 for cases and controls, respectively. Significant differences were observed in the frequencies of DD, ID, and II genotypes among the hypertensive and normotensive groups which were found to be 29.7%, 38.7%, and 31.5% vs. 53.7%, 23.4%, and 22.9%, respectively. It has been observed that the ACE ID genotype was significantly (p < 0.05) higher in hypertensive subjects, whereas, the DD genotype was significantly (p < 0.05) higher in control subjects. A strong association was found between cardiovascular diseases (CVDs) and ID genotype [p = 0.017, odds ratio (OR) = 3.091, 95% confidence interval (CI) = 1.224-7.807]. ID [p = 0.002, OR = 2.020, 95% CI = 1.281-3.185] and II [p = 0.032, OR = 1.677, 95% CI = 1.044-2.694] genotypes are more prone to diabetes with hypertension. This finding suggests that ACE insertion/deletion polymorphism is associated with hypertension and additive diseases in North Indians.

Free radicals hasten head and neck cancer risk: A study of total oxidant, total antioxidant, DNA damage, and histological grade.

BACKGROUND: Free radicals such as reactive oxygen species (ROS), which induce oxidative stress, are the main contributors to head and neck carcinogenesis (HNC). The present study was conducted with the aim to assess the oxidant/antioxidant status and DNA damage analysis in head and neck cancer/control patients. MATERIALS AND METHODS: This prospective study was conducted on 60 patients with biopsy-proven HNC and 17 patients of head and neck disease (HND). The total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were determined by novel automatic colorimetric methods from tissue homogenate. DNA damage analysis was determined by single cell gel electrophoresis (SCGE). RESULTS: The mean age of the study cohort was 46.65 ± 14.84 years for HNC patients, while it was 49.41 ± 13.00 years for HND patients. There were no significant differences found between the two groups with respect to demographic presentation except tobacco addiction. The association between oxidative stress parameters and DNA damage analysis with study group revealed the following. (A) DNA damage - tissue homogenate TOS and OSI were significantly higher in HNC subjects than in HND (16.06 ± 1.78 AU vs 7.86 ± 5.97 AU, P < 0.001; 53.00 ± 40.61 vs 19.67 ± 21.90, P < 0.01; 7.221 ± 5.80 vs 2.40 ± 2.54, P < 0.01, respectively), while TAS was significantly decreased. (B) Aggressive histological features were identified, more commonly with higher TOS and lower TAS [probability (P) = 0.002, relative risk (RR) = 11.838, 95% confidence interval CI = 2.514-55.730 and P = 0.043, RR = 0.271, 95% CI = 0.077-0.960, respectively]. CONCLUSION: The increase in free radicals may be the event that led to the reduction of antioxidant status in HNC, thus explaining the oxidative damage of DNA and the severity of disease. Increased OSI represents a general mechanism in its pathogenesis.

Molecular genetics of essential hypertension.

Hypertension is a major public health problem in the developing as well as in developed countries due to its high prevalence and its association with coronary heart disease, renal disease, stroke, peripheral vascular disease, and related disorders. Essential hypertension (EH) is the most common diagnosis in this disease, suggesting that a monocausal etiology has not been identified. However, a number of risk factors associated with EH have also been identified such as age, sex, demographic, environmental, genetic, and vascular factors. Recent advances in molecular biological research had achieved clarifying the molecular basis of Mendelian hypertensive disorders. Molecular genetic studies have now identified mutations in several genes that cause Mendelian forms of hypertension in humans. However, none of the single genetic variants has emerged from linkage or association analyses as consistently related to the blood pressure level in every sample and in all populations. Besides, a number of polymorphisms in candidate genes have been associated with differences in blood pressure. The most prominent candidate has been the polymorphisms in the renin-angiotensin-aldosterone system. In total, EH is likely to be a polygenic disorder that results from inheritance of a number of susceptibility genes and involves multiple environmental determinants. These determinants complicate the study of blood pressure variations in the general population. The complex nature of the hypertension phenotype makes large-scale studies indispensable, when screening of familial and genetic factors was intended. In this review, recent genetic studies exploring the molecular basis of EH, including different molecular pathways, are highlighted.

Quantitative Assessment of Muscle Activity and Joint Load in Braced and Unbraced Osteoarthritis Knee by External Strain Gauge Sensor.

OBJECTIVES: Altered biomechanics leads to the development of degenerative joint disease. The joint pressure and dynamic loading varies during activities of daily living. The study was undertaken to assess the muscle activation pattern of the medial and lateral knee compartments (tibiofemoral joint) during gait in osteoarthritis subjects without and with knee brace undergoing either exercise therapy or balance therapy. The joint load was assessed by the strain gauge transducer and the weight shift pattern is taken as an indicator for the muscle activation pattern. METHODS: In a prospective design study on 57 male subjects diagnosed osteoarthritis knee with Kellagren-Lawrennce scale walked barefooted with and without designed offloader knee brace on a level surface for three minutes. The subjects were allocated in two different study groups i.e. Conventional (exercise therapy) (Control Group, n=31) and Structured Neuromuscular Postural Training (SNPT) group (Balance therapy) (Study Group, n=26). The subjects were sub grouped as pre-elderly (40-60 Years) and elderly (>61 years) group in both. The quantitative assessment of muscle activity and joint loading with and without knee brace was done using designed strain gauge sensor instrument. The pressure changes of strain gauges of muscles around the knee joint viz. vastus medialis (VM), vastus lateralis (VL), semi membranosus/tendinosus (Medial Hamstring) (MH), Biceps Femoris (Lateral Hamstring) (LH), gastro-soleus (GS) and tibialis anterior (TA) muscles during normal gait were observed at baseline and 6 weeks follow up after undergoing exercise therapy or balance therapy treatment as per allocation of study groups. The digital values from MATLAB were recorded and analyzed. RESULTS: At the end of 6 weeks conventional/SNPT (structured neuromuscular postural training) treatments, medial hamstring muscle activity showed significant difference (p<0.001) in pre-elderly subgroup, while significant difference was seen in vastus laterals (VL), medial hamstring (MH) (p<0.005) and lateral hamstring (LH) muscles (p<0.001) in elderly subgroup. Further, the muscle co-contraction has been higher for vastus medialis-medial hamstring (VM-MH) pair compared to vastus lateralis-lateral hamstring (VL-LH) pair without brace at baseline. The application of offloader valgus knee brace significantly increases VL-LH co-contractions in magnitude and decreases in VM-MH co-contractions at 6 weeks follow up. CONCLUSION: Muscle activity increased in medial hamstring both in pre-elderly and elderly subjects. While, Vastus Laterals and lateral hamstring showed increased activities in elderly subjects. Hence, balance training and the application of off loader knee brace will be helpful to redistribute the load on medial tibiofemoral compartment.

Cryptococcal meningitis with an antecedent cutaneous Cryptococcal lesion.

Cutaneous cryptococcosis, caused by an encapsulated yeast, Cryptococcus neoformans, is generally associated with concomitant systemic infection. Here we report a case of primary cutaneous cryptococcosis with spread to central nervous system in an HIV seronegative young boy. In the present case, a 17-year-old boy who was suffering from a non-healing ulcer on his right great toe for 5 months, presented with the signs and symptoms of meningitis. Cryptococcus neoformans var. gattii was isolated from the CSF of the patient. Amphotericin B administration produced recovery from the meningitis as well as from the ulcer. This case study suggests that primary cutaneous cryptococcosis can be diagnosed provisionally by a simple Gram stained smear and India ink examination in order to avoid occurrence of disseminated cryptococcosis, including meningial involvement, which may have a fatal outcome.

Health status of elderly population in rural area of Varanasi district.

In order to assess the health problems of the elderly people and its relationship with advancement of age, a field based cross sectional study was carried out in two selected villages in the rural field practices area in Varanasi district. 88.8 % were found to suffer from one or more illness at the time of study. This resulted in the morbidity load of 1.93 illnesses per person. The morbidity was directly proportional to the age. The most common morbidity was arthritis with overall prevalence of 57.08% followed by cataract (48.33%), hypertension (11.25%). But the prevalence of old age related morbidities increased with advancing age (p<0.008). Compared to married people higher percentage of widow / widower (91.5%) suffered from old age related morbidities (p<0.01).

Significance of Cryptosporidium as an aetiology of acute infectious diarrhoea in elderly Indians.

OBJECTIVE: To explore the significance of Cryptosporidium isolation in elderly Indian with acute infectious diarrhoea and its clinical correlates. DESIGN: A hospital-based clinico-aetiological study of 120 patients aged 60 years or older, 25 adults younger than 60 years and 25 children up to age 14 with acute diarrhoea, and 57 apparently healthy elderly individuals. RESULTS: Cryptosporidium was isolated in 22 older patients with diarrhoea (18.3%) and was highly significant (P < 0.01) compared with healthy age-matched controls. Of these patients 66% had a history of close contact with animals. Most (68%) Cryptosporidium infections occurred during the rainy season. Among the elderly patients 17% suffered from vomiting and abdominal pain, 31% were febrile; none were severely dehydrated. Stools numbered three to nine per day with duration of 5-17 days. Stool leucocytes were <6/hpf and no RBCs were seen. Isolation of Cryptosporidium in older persons was associated with diabetes mellitus (22.7%), tuberculosis (9.0%), malignancy (4.5%) and coronary artery disease (4.5%). CONCLUSION: Cryptosporidium is an important cause of diarrhoea in elderly Indians, especially those with close contact with animals. The infection has a mild clinical course, is self-limiting and does not cause dysenteric stool. Its effect on nutrition requires further study.

Herpes simplex virus-1 encephalitis in eastern Uttar Pradesh.

OBJECTIVE: To study the proportion of HSV-1 encephalitis in acute viral encephalitis. METHODS: One hundred and five patients presenting with clinical diagnosis of acute viral encephalitis and with exclusion of other possible causes of acute inflammatory brain disease prevalent in the area by relevant laboratory investigations were included in the study. Ninety single CSF samples were tested for HSV-1 IgM antibodies by ELISA test supplied by Dia Medix Corporation, USA. CT Scan and EEG studies were carried out in 25 patients. RESULTS: Clinical and neuro investigational profile of patients suggested a low incidence of HSV-1 encephalitis in the study group. IgM antibodies were present in CSF sample of one patient only. CONCLUSION: HSV-1 encephalitis constitutes a very low proportion (1.1%) of acute viral encephalitis cases seen in Eastern Uttar Pradesh (India).

Evaluation of CSF-adenosine deaminase activity in tubercular meningitis.

Sixty patients of inflammatory brain disease were diagnosed and classified according to clinico-investigational criteria by Ahuja et al into tuberculous meningitis group (36 patients) and non-tuberculous meningitis group (24 patients). Tuberculous meningitis (TBM) patients were classified as probable (9 patients) and possible (27 patients) TBM. Non-TBM group comprised of pyogenic meningitis (8.3%), viral encephalitis (23.3%), cerebral malaria (5%) and enteric encephalopathy (3.3%). Cerebrospinal fluid-adenosine deaminase (CSF-ADA) activities were measured in both TBM and non-TBM groups. Mean CSF-ADA levels in TBM patients was 9.61 +/- 4.10 IU/L and was significantly elevated as compared to viral encephalitis and enteric encephalopathy cases; but difference was insignificant in comparison to pyogenic meningitis (7.92 +/- 0.95 IU/L) and cerebral malaria. Using 8 IU/L as cut off value for diagnosis of TBM a sensitivity of 44% and specificity of 75% was observed.

Evaluation of muscle changes in patients with chronic renal failure.

Forty patients of chronic renal failure (CRF) and five patients of acute on chronic renal failure (ACRF) were evaluated clinically and electrophysiologically for involvement of muscles. EMG studies showed features suggestive of denervation myopathy in 10 of patients of CRF only. Histopathological study of muscle biopsies, done in 25 patients with CRF, showed constellation of histopathological features suggestive of denervation myopathy in 48 and toxic myopathy in 24. In five patients with ACRF,denervation myopathy was observed in 60 and toxic myopathy in 20 cases on histopathological examination.

Prognostic parameters of CT scan in spontaneous intracerebral haemorrhages.

Eighty six C. T. scan proven cases of intracerebral hemorrhage were studied. The mean age was 58 ñ 14.5 years with the majority (65 percent) of the patients in the 5th and the 6th decades. Our data revealed that the state of alertness and the prognosis had a significant correlation with the location, the volume of hemorrhage, presence of ventricular communication and the degree of mass effect. The mortality was 43 percent and the survivors improved significantly at the time of discharge.

Tropical pyomyositis in India: a clinico-histopathological study.

Eighteen cases of tropical pyomyositis, aged 12-45 years, were seen over a 3-year period. There was clustering of cases in January, February and July to October. Male:female ratio was 14:4. Multiple muscular lesions (greater than 2) were common (67%). Extramuscular complications were present in 50% of the cases. Cardio-pulmonary involvement was most frequent. Muscle biopsies, done in 16 cases, showed suppurative changes (pus) in 15 cases and one case of non-suppurative myositis. Muscle necrosis, cellular infiltration with polymorphs and haemorrhage in-between muscle fibres were common.

Sublingual nifedipine in hypertensive emergencies with special reference to cerebrovascular accident.

Effect of sublingual nifedipine was evaluated in 39 cases of hypertensive emergencies (diastolic blood pressure greater than or equal to 120 mm Hg with impending organ failure, loss of vital function or death). It was found to be effective (95%), safe, with prompt (with 15 minutes) and predictable response (lowering of systolic blood pressure, diastolic blood pressure, mean arterial pressure by 30% at the end of 3 hours), and few adverse effects. Its use in patients of cerebrovascular accident (24 cases) was found to be effective and safe without any significant clinical problem or increased mortality.