Impact of diabetic retinopathy on pulse wave analysis-derived arterial stiffness and hemodynamic parameters: A cross-sectional study from Gujarat, India.

PURPOSE: Type 2 diabetes mellitus (T2DM) is known to produce diabetic retinopathy (DR). Pulse wave analysis (PWA) provides arterial stiffness (AS) and central hemodynamic (CH) parameters. We studied the effect of DR on AS and CH parameters in type 2 diabetics (T2D). METHODS: We performed a cross-sectional study on 47 T2Ds attending a private ophthalmology clinic screened for DR by optical coherence tomography angiography and divided into NDR (non-DR), NPDR (non-proliferative DR), and PDR (proliferative DR). Mobil-o-graph (IEM, Germany) based oscillometric PWA yielded AS and CH parameters. They were further compared between groups stratified by DR with P value set at 0.05. RESULTS: Participants had a mean age 62, mean diabetes duration 9 years, high mean BMI, and high prevalence of physical inactivity, hypertension, and poor diseases control. Significant differences were lacking in NPDR, NDR, and PDR in rate pressure product (mean 112.71 vs 116.06 vs 119.57), central pulse pressure (mean 46.50 vs 43.09 vs 42.72), stroke work (mean 153.36 vs 132.36 vs 146.08), augmentation index (mean 29.43 vs 33.14 vs 31.64), and aortic pulse wave velocity (mean 10.06 vs 9.08 vs 9.06). There was no clear pattern of distribution of most parameters among the three subgroups. CONCLUSION: We found a lack of association between DR and cardiovascular ageing studied by AS and hemodynamic parameters. It suggests a possible difference in risk factors for both of these aftermaths of T2DM and calls for further prospective studies with a large sample size.

Effect of Menopause on Arterial Stiffness and Central Hemodynamics: A Pulse Wave Analysis-Based Cross-sectional Study from Gujarat, India.

BACKGROUND: Menopause, a cardiovascular risk in mid-life women, is studied in terms of blood pressure mostly. Arterial stiffness (AS) and central hemodynamics (CH) are direct surrogates measured by pulse wave analysis (PWA) with no study from our region. OBJECTIVE: We studied AS, CH in relation to menopause using PWA. MATERIALS AND METHODS: A cross-sectional study was performed in 134 middle-aged females divided into groups with or without menopause. Oscillometric PWA done by Mobil-o-Graph (IEM, Germany) gave - AS like augmentation pressure, augmentation index at heart rate (HR) 75, aortic pulse wave velocity (aPWV), and total AS pulse pressure amplification; CH like aortic blood pressure, cardiac output and related parameters, peripheral resistance, stroke work, prevalent brachial/central hypertension, and raised central pulse pressure. They were further compared between groups, in relation to body mass index (BMI) and by multiple regressions with P < 0.05 as statistical significance. RESULTS: Postmenopausal women were significantly elder, physically inactive with comparable BMI and showed higher AS (only aPWV was significantly different) and CH. BMI was unrelated to AS or CH in postmenopausal group. Age (except for aPWV), BMI, and HR (except for AIx@75) were insignificant predictors, while systolic blood pressure (SBP) in premenopausal and diastolic blood pressure (DBP) in postmenopausal group was major AS predictors. Age, HR, and BMI were insignificant predictors, while SBP more than DBP was significant predictors of CH. CONCLUSIONS: In obese, predominantly sedentary midlife Gujarati women, menopause negatively affects AS and hemodynamics, central more than peripheral. Menopause accelerates cardiovascular aging, independent of BMI, and age that calls for further studies.

Association of brachial and central hemodynamic parameters to eGFR and proteinuria in Gujarati diabetics with mild-to-moderate nephropathy.

INTRODUCTION: Diabetes mellitus (DM) is a significant risk factor for nephropathy and cardiovascular morbidity. Pulse wave analysis (PWA) gives direct inference of brachial hemodynamics (BH) and central hemodynamics (CH). We studied relation of them with diabetic nephropathy (DN) among type-2 diabetics (T2D). METHODS: We studied oscillometric PWA by a cross-sectional study in 160 T2Ds. Using Mobil-o-Graph (IEM, Germany), we derived BH (blood pressure, pulse pressure index, rate pressure product) and CH (aortic pressure, cardiac index, stroke volume index, stroke work). They were further compared and associated with DN in terms of creatinine, proteinuria, and estimated glomerular filtration rate (eGFR). RESULTS: There were 89 males, mean age 56 years, mean duration 4.8 years, 80% hypertensive predominantly using ACE inhibitors, poor glycemic blood pressure (BP) control, mainly mild-to-moderate DN, mean eGFR 88.2, 34% prevalence of proteinuria. Arterial stiffness was high with female disadvantage. BH and CH parameters were not different with or without DN using proteinuria or eGFR (60 cutoff) criteria. BH, CH correlated insignificantly with creatinine and eGFR. Female disadvantage, correlation with bSBP and aSBP were only significant results. CONCLUSIONS: BH and CH are not related to eGFR and proteinuria in predominantly hypertensive, Gujarati diabetics with mild-to-moderate nephropathy suggesting need of other cardiovascular parameters.

Central hemodynamics and arterial stiffness by oscillometric pulse-wave analysis in treated Gujarati euglycemic hypertensives: A case-control study.

INTRODUCTION: Hypertension is the most prevalent noncommunicable disorder, studied in terms of brachial blood pressure. Direct parameters like central hemodynamics and arterial stiffness, though superior, are not studied much. The same can be studied by pulse-wave analysis (PWA) and we did that in euglycemic treated hypertensives. MATERIALS AND METHODS: A case-control study was conducted in 258 treated euglycemic hypertensives and 258 matched controls. Oscillometric PWA was accomplished by Mobil-O-Graph (IEM, Germany). Parameters were further analyzed for the effect of gender, physical activity, body mass index (BMI) (cutoff 23), blood pressure control, and duration (cutoff 5 years). Multiple linear regressions were used to find significant predictors. P < 0.05 was taken as statistically significant. RESULTS: Cases had significantly higher brachial arterial parameters (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse-wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) compared to age, gender, and BMI-matched controls. In the case group, female gender, BMI ≥ 23, and uncontrolled blood pressure were significant factors affecting results. Heart rate and pulse pressure were major predictors of study parameters. Central pressure parameters were not predicted significantly by corresponding brachial pressure parameters. CONCLUSION: PWA revealed the adverse profile of arterial stiffness and central hemodynamics in treated Gujarati hypertensives, associated with female gender, BMI, and blood pressure control, predicted mainly by heart rate and pulse pressure, independent of brachial blood pressure. It indicates both potential and further study of these parameters.

Central hemodynamics and arterial stiffness in Gujarati diabetics not receiving any antihypertensive: A case-control study based on oscillometric pulse wave analysis.

INTRODUCTION: Diabetes is a modern epidemic imposing significant cardiovascular risk. Immediate and discrete parameters such as arterial stiffness and central hemodynamics are studied scarcely. Pulse wave analysis (PWA) offers noninvasive measurement of the same and we performed that in diabetics. MATERIALS AND METHODS: We performed a case-control study on 148 treated diabetic not on antihypertensive and 148 nondiabetic normotensive controls. Oscillometric PWA was performed by Mobil-O-Graph (IEM). Parameters were further analyzed for effect of gender, physical activity, body mass index (BMI; cut-off 23), glycemic control, and disease duration (cut-off 4 years). Multiple linear regressions were used to find significant predictors. P <0.05 was taken as statistical significance. RESULTS: Cases had significantly raised brachial hemodynamics (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥ 23, and physical inactivity were the significant factors affecting results (arterial stiffness more than central hemodynamics); glycemic control and duration were not. Heart rate was the major predictor of study parameters. Brachial pressure parameters were not significant predictors of corresponding central pressure parameters. CONCLUSION: Gujarati diabetics not using any antihypertensive had adverse profile of beyond brachial blood pressure discrete cardiovascular parameters, independent of duration and glycemic control, related to gender, BMI, and physical activity, indicating vascular progeria in the absence of hypertension. This baseline study suggests further work on these potential parameters.

Abnormal sympathetic functioning is linked to familial hypertension in nonathletic young males.

BACKGROUND: Sympathetic overactivity mediates abnormal cardiovascular outcome that is affected by stress, lack of physical activity (PA), and familial hypertension (HTN). It can be assessed by blood pressure-based sympathetic function tests. OBJECTIVE: We studied sympathetic function tests in young nonathletic males in relation to measures of obesity, PA, and familial HTN. METHODOLOGY: We recruited 100 males (mean age: 19 years) and measured body mass index (BMI) and body composition parameters by tetrapolar bioelectrical impedance such as total body fat, visceral fat, subcutaneous fat, and skeletal muscle mass. Using instrument cardiac autonomic neuropathy system of Recorders and Medicare System Company, India, blood pressures (supine, standing, and post hand grip) were recorded and studied quantitatively and qualitatively. RESULTS: Physically active and inactive individuals (n = 50 each) had comparable age, BMI, measures of obesity, and sympathetic function tests. However, individuals with familial HTN (n = 37) showed significantly higher obesity measures and blood pressures (supine: systolic blood pressure [SBP] - 133 vs. 115 and diastolic blood pressure [DBP] - 79 vs. 76; standing: SBP - 136 vs. 122 and DBP - 80 vs. 76; post hand grip: SBP - 136 vs. 125 and DBP - 86 vs. 81). Qualitatively, postural hypotension was seen in only two individuals, while worst grading was in post hand grip test significantly and more so in physically inactive group (30%, 28%, and 42% vs. 16%, 20%, and 64%) and individuals with positive familial HTN (32%, 38%, and 30% vs. 17%, 13%, and 70%). CONCLUSION: Familial HTN, but not physical inactivity, affects sympathetic functioning in nonathletic young male medical personnel. It asks for other lifestyle modifications for better cardiovascular health as primary prevention.

Pulse wave analyzed cardiovascular parameters in young first degree relatives of hypertensives.

BACKGROUND: First-degree relatives (FDRs) of hypertensive (HT) are predisposed to hypertension (HTN) which accelerates cardiovascular aging. Same can be studied noninvasively by pulse wave analysis (PWA), encompassing central hemodynamics such as central blood pressure (cBP), cardiac output, and stroke work (SW) and vascular stiffness parameters such as pulse wave velocity (PWV) and augmentation index at HR 75 (AIx@75). We studied PWA-derived cardiovascular parameters in FDRs of HT compared to controls. MATERIALS AND METHODS: We conducted a case-control study in 119 FDRs of HT and 119 matched controls. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) and cardiovascular parameters were compared. P < 0.05 was considered statistically significant. RESULTS: Groups were comparable with gender, age, height, weight, body mass index, and physical activity. FDRs of HT had significantly higher brachial and cBPs, SW (101.41 ± 25.44 vs. 88.31 ± 20.25, P = 0.001), rate pressure product-119.40 ± 25.34 vs. 108.34 ± 18.17, P < 0.0001), PWV (5.22 ± 0.46, P < 0.0001), and AIx@75 (31.48 ± 9.01 vs. 27.95 ± 9.4, P = 0.002) than control. Dependent study variables correlated with brachial blood pressure more in magnitude and significance level than age or anthropometric variables. PWA results of FDR with maternal inheritance did not differ significantly from those with paternal inheritance. CONCLUSION: PWA reveals early cardiovascular aging in young FDRs of HTs. It clues to future cardiovascular disease including HTN itself, need for primary prevention, and further study for consolidation of these results.

Early Screening of Hypertension and Cardiac Dysautonomia in Each Hypertensive is Needed-inference from a Study of QTc Interval in Gujarat, India.

BACKGROUND: Hypertension (HTN) is linked to cardiac dysautonomia that can end up as life-threatening arrhythmias. The same can be screened by simple electrocardiogram (ECG)-based QTc (QT corrected for heart rate) interval which indicates repolarization abnormality. We quantified QTc interval among treated hypertensives in comparison to controls, testing effect of age, gender, and blood pressure. METHODS: We conducted a cross-sectional study was done at a tertiary care teaching hospital of Gujarat, India, on 142 hypertensives on monotherapy (60 males, 82 females) and 72 age-, sex-, and time-matched normotensives. ECG was recorded with minimum 10 complexes of Lead II. QTc was derived from average of 10 values, using Bazett's formula. QTc > 0.43 s in male and > 0.45 s in female was considered abnormal. RESULTS: Hypertensives (mean age 40 and duration 5 years) had significantly higher QTc value than normotensives among males (0.42 vs. 0.40, P < 0.001), females (0.44 vs. 0.41, P < 0.001), and in total (0.43 vs. 0.41, P < 0.001) with 24% prevalence of ECG-based left ventricular hypertrophy. Hypertensives had odds ratio 1.63 in males (P = 0.15), 23.71 in females (P = 0.003), and 3.83 in total (P < 0.001) for prolonged QTc. QTc values were significantly affected by increasing age amongst hypertensives but not by duration of HTN or current blood pressure. CONCLUSIONS: Our study showed a high prevalence of prolonged QTc, both qualitatively and quantitatively, in hypertensives on monotherapy with poor pressure control, associated with female gender and age but not duration or blood pressure. This underscores high risk of repolarization abnormality induced future event, suggesting QTc screening as primary prevention.

Pulse wave analyzed cardiovascular parameters in young first degree relatives of type 2 diabetics- a cross-sectional study.

BACKGROUND: First degree relatives (FDR) of type 2 diabetic (T2D) are predisposed for type 2 diabetes mellitus (T2DM) which accelerates cardiovascular aging. Pulse wave analysis (PWA) gives non-invasive measurement of central hemodynamics like central blood pressure (cBP), cardiac output (CO), stroke work (SW) and vascular stiffness like pulse wave velocity (PWV) and augmentation index at heart rate 75 (AIx@75). OBJECTIVE: To study PWA derived cardiovascular parameters in FDRs of T2D as compared to controls. MATERIALS AND METHODS: We enrolled 117 FDRs of T2D and 117 matched controls for a cross-sectional study. We performed PWA using Mobil-o-Graph (IEM, Germany) by oscillometric method to derive cardiovascular parameters which were compared and correlated for significance. P value less than 0.05 was considered statistically significant. RESULTS: Gender, age, height, weight, body mass index (BMI), physical activity were comparable between groups. FDRs of T2D had significantly higher blood pressure (brachial-systolic 125 vs 118, diastolic 80 vs 77, mean 100 vs 96mmHg and central- systolic 113 vs 105, diastolic 82 vs 79, pulse pressure 31 vs 28mmHg), SW (98 vs 90gm/bt), rate pressure product (RPP- 113 vs 107), PWV (5.14 vs 4.89m/s), AIx@75 (30 vs 27) than control. Dependant variables correlated with brachial BP more than age or anthropometric variables. Result did not differ by maternal or paternal inheritance in case group. CONCLUSIONS: Young, sedentary, non-obese FDRs of T2D have adverse cardiovascular profile which is suggested to worsen before or with onset of T2DM and definitely need attention for life style modification as primary prevention.

A cross-sectional study of variations in the biophysical parameters of skin among healthy volunteers.

BACKGROUND: Biophysical parameters of skin such as trans-epidermal water loss (TEWL), hydration, elasticity, pH, and sebum reflects it functional integrity. Advances in technology have made it possible to measure these parameters by non-invasive methods. These parameters are useful for the prediction of disease and its prognosis. It also helps in developing new skin care products according to various skin types, and to evaluate, modify, or compare the effects of existing products. AIM: The aim of the study was to measure, evaluate, and analyze variations in biophysical parameters at pre-selected skin sites in healthy Indian volunteers, across different age groups and gender. METHODS: The study was conducted among 500 healthy Indian volunteers, between 5 and 70 years of age, in the outpatient department of dermatology at Sir T. Hospital, Bhavnagar. Biophysical parameters such as TEWL, hydration, elasticity, and sebum content was measured on four pre-selected body sites by a Dermalab instrument (Cortex Technology, Denmark). The skin pH was measured with a sensitive pH probe (BEPL 2100). RESULTS: All parameters were higher in males compared to females, except for sebum content, which was equal in both genders. Transepidermal water loss and hydration was lower in middle and older age groups. The skin pH showed no statistically significant difference with age. Sebum content was higher in middle and older age groups. The nose had the highest sebum content across all age groups. The forehead showed higher median values of TEWL and hydration compared to other sites. Though elasticity has highest value on forearm, only leg region showed statistically significant value. LIMITATIONS: The present study was confined to a single geographical area, so the effect of environment changes could not be judged accurately. Seasonal variations were not studied as it was a cross-sectional study. CONCLUSION: Skin properties vary with age, gender, and location on the body. This knowledge will help to create a database of these parameters in the Indian population. It would assist in the diagnosis of various clinical conditions and monitor therapeutic response.

Knowledge, attitude, and practice of urban Gujarati type 2 diabetics: Prevalence and impact on disease control.

CONTEXT: Type 2 diabetes is the modern epidemic wherein patient care needs multiple approaches, education, and self-awareness being one of them. There are some knowledge, attitude, and practice (KAP) studies from India but very few relating it with disease control. AIMS: We tried to study KAP of treated type 2 diabetics and its correlation with glycemic control. SETTINGS AND DESIGN: Cross-sectional KAP study. SUBJECTS AND METHODS: We formulated KAP questionnaires in the form of KAP - 10 points for each and total 30. We recruited 200 type 2 diabetics (96 males, 104 females) treated by MD physicians with known current glycemic status. They were asked KAP questionnaires one to one by a direct interview in local language and results were associated with various factors and glycemic control. RESULTS: KAP score on was average 19 out of 30 in type 2 diabetics having mean age 58 years, mean duration 9 years. KAP score was unaffected by gender, occupation, duration of disease but significantly affected by current age, and education level. Only 40% patients had good glycemic control who scored better KAP than poor glycemic. There was positive correlation between KAP score and glycemic control, with significance for only glycosylated hemoglobin and not fasting blood sugar, postprandial blood sugar. CONCLUSIONS: Physician treated type 2 diabetics of our region had moderate KAP score, affected by age, education which suggested to affect glycemic control. Lacunae in knowledge regarding incurability of disease, attitudes toward complication, self-care, and good practices like walking, enriching knowledge need improvement so as an optimum glycemic control.

Comparative study of cardiac autonomic status by heart rate variability between under-treatment normotensive and hypertensive known type 2 diabetics.

BACKGROUND: Co-existence of hypertension is known in three quarter of Indian type 2 diabetics, this duo having adverse additive effect on cardiovascular health including dysautonomia. Latter can be measured by simple 5min heart rate variability (HRV) using simple electrocardiogram, which if reduced indicates cardiac risk. OBJECTIVE: We compared HRV parameters between hypertensive and normotensive type 2 diabetics, looking for significant difference if any. MATERIALS AND METHODS: 98 hypertensive and 40 normotensive type 2 diabetics treated as outpatients were evaluated for disease control and risk stratification. Fivemin resting HRV was measured by Variowin HR, software based instrument, using standard protocols to record time domain, frequency domain and Poincare plot parameters. They were compared between groups for difference. RESULTS: Mean age was 56 and 51 years, duration 6 years and 4 years respectively in hypertensive (HT) and normotensive (NT) group of type 2 diabetics, which did not significantly differ in distribution of risk factors. There was poor glycaemic control (one third) in both groups and good pressure control in HT group. Both groups revealed all reduced HRV parameters with significant difference in-between only for LF/HF ratio (1.29 in HT vs 2.61 in NT group). CONCLUSION: Our findings of HRV suggest that in type 2 diabetics with poor glycaemic and good pressure control, hypertension as a co-existing factor does not make significant difference in cardiac dysautonomia emphasizing residual risk despite antihypertensive treatment and need for early HRV screening, strict glycaemic control and other interventions.

Impact of disease control and co-existing risk factors on heart rate variability in Gujarati type 2 diabetics: An observational study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a proven threat of cardiac dysautonomia with paucity of studies from India. Poor disease control makes it further worse with co-existence of hypertension in majority. Heart rate variability (HRV) is a validated noninvasive tool to assess cardiac autonomic status. AIM: We studied HRV parameters of type 2 diabetics looking for effects of disease control and other co-existing risk factors. MATERIALS AND METHODS: Ninety-eight hypertensive and forty normotensive under-treatment, Gujarati type 2 diabetics were evaluated for disease control and risk stratification. Five minutes resting, HRV was measured by Variowin HR, software-based instrument, using standard protocols to record time domain, frequency domain, and Poincare plot HRV parameters. They were compared between subgroups for the difference with P < 0.05 defining statistical significance. RESULTS: All HRV parameters were reduced in type 2 diabetics, having mean age 56 years, mean duration 6 years with poor glycemic but comparatively better pressure control. HRV parameters were significantly not different in good compared to poor glycemics or in subjects with optimum pressure control than those without it. Results did not differ significantly, by the presence of individual cardiovascular risk factor in diabetics except resting heart rate. CONCLUSION: Our findings of HRV suggest that type 2 diabetics with poor glycemic control do not have a significant difference of cardiac dysautonomia by pressure control, glycemic control, and absence of risk cardiovascular factor. It suggests diabetes as a major cause for cardiac dysautonomia, residual risk despite treatment and need for HRV screening, strict glycemic control, and further studies.

Is the peripheral arterial disease in low risk type 2 diabetic patients influenced by body mass index, lipidemic control, and statins?

OBJECTIVE: To correlate BMI, lipidemic control, and statin therapy with PAD measured by ABI in low risk type 2 diabetics. MATERIALS AND METHODS: A sample of 101 nonsmoking, asymptomatic type 2 diabetics (50 males, 51 females) with known glycemic (fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin) and lipidemic (total cholesterol, lipoproteins, and triglycerides [TGAs]) control was taken. Vascular Doppler was used to derive ABI and PAD was defined as ABI <0.9. ABI values were compared amongst groups and P < 0.05 was considered statistically significant. RESULTS: We found fairly good lipid but poor glycemic control and prevalence of PAD 30%. There was insignificantly low ABI profile in patient having BMI ≥25, hyperlipidemia and absent statin therapy with odds ratio being highest for TGAs ≥150 (3.23) followed by BMI ≥25 (2.61), high-density lipoprotein ≤50 (1.61), low-density lipoprotein ≥100 (1.20), and disuse of statin (1.14) with significance only for BMI. CONCLUSION: We observed small, insignificant PAD risk by dyslipidemia or non-use of statins in low-risk ambulatory T2DM patients, not so by BMI. This suggests importance of good glycemic control, maintenance of optimum weight, and lifestyle modifications as primary prevention rather than opting for costly and inefficient secondary prevention.

Lung Transfer Factor in Middle Aged Asymptomatic Male Smokers of a City from West India: A Cross-Sectional Study.

INTRODUCTION: Smoking is an increasingly popular indulgence in India. Assessment by routine spirometry falls short of direct functional parameter like Diffusion Lung Capacity (DLC), also known as lung transfer factor (LTF). AIM: To measure LTF amongst middle aged male smokers and to study various correlates for it. MATERIALS AND METHODS: Total of 45 asymptomatic male current smokers were enrolled for this cross-sectional study conducted at pulmonary function testing lab of Physiology Department of our college. Smoking history was evaluated and smoking index was defined by product of number smoked per day and years smoked. We used instrument Ultima PFX of Medgraphic Company. After pre syringe calibration LTF was measured by Methane mixture using protocols of ATS. Parameters measured were Dlco-uncorrected, corrected and normalized to VA (alveolar volume). Results were compared for statistical significance and significance was set as p <0.05. RESULTS: In case group of 45(25 bidi and 20 cigarette smokers) mean age was 30 years, mean duration was 8 years, mean smoking index was 60. We found small insignificant decline in actual LTF values than predicted which was not significantly different between bidi and cigarette smokers. Duration, age and intensity of smoking were negatively and significantly correlated with LTF value while anthropometric parameters were not. CONCLUSION: Smoking adversely affects LTF in young asymptomatic current male smoker that further declines with severity of smoking and with duration regardless of type of smoking. With years to come, these alterations can largely be prevented by smoking cessation, at least theoretically.

Effect of current glycemic control on qualitative body composition in sedentary ambulatory Type 2 diabetics.

BACKGROUND: Obesity and Type 2 diabetes mellitus are on rise with cause-effect relationship. Diabetics monitor blood sugar, neglecting qualitative body composition, leaving residual threat of ectopic fat unattended. We tried to correlate glycemic triad with parameters of body composition derived objectively by bioelectrical impedance analysis (BIA). MATERIALS AND METHODS: A sample of 78 under treatment sedentary Type 2 diabetics of either sex with known glycemic and lipidemic control from our city. Following baseline assessment measurement was done by instrument Omron Karada Scan (Model HBF-510, China) using the principle of tetra poplar BIA to derive parameters of body composition. We tried to correlate glycemic triad with these parameters, both directly as well as after defining them as per established cutoff norms. RESULTS: We found poor glycemic control in the study group (20% for Hb1AC), high body mass index, subcutaneous fat, visceral fat (VF), total body fat (TBF), and lesser mass of skeletal muscle in Type 2 diabetics. However, there were small, insignificant, and inconsistent difference of these parameters while directly correlating with the fasting blood sugar, postprandial blood sugar, and glycosylated hemoglobin. On qualitative assessment, the impact of glycemic control as per standard norms, the risk of high VF, high TBF, low skeletal muscle mass was though high (between 1 and 2) in Type 2 diabetics with poor glycemic control as compared to good glycemics, but each strength lacks statistical significance. CONCLUSION: BIA reveals that Type 2 diabetics have more ectopic fat on expense of skeletal muscle that do not correlate with current glycemic status, both quantitatively and qualitatively. Measurement of body composition can be included and subjects can be motivated for lifestyle modification strategies while managing metabolic derangements of Type 2 diabetes.

QTc interval in young Gujarati hypertensives: Effect of disease, antihypertensive monotherapy, and coexisting risk factors.

OBJECTIVES: To study the effect of disease duration, treatment and risk factors on QTc interval among young hypertensives. MATERIALS AND METHODS: A case-control study was conducted on 142 hypertensives (60 males, 82 females) taking calcium channel blocker (CCB) or angiotensin-converting enzyme inhibitor (ACEI) as monotherapy. After blood pressure measurement, we recorded lead II electrocardiograph with minimum ten waveforms. QTc was derived from average of ten values using Bazett's formula. QTc interval >0.43 s in male and >0.45 s in female was considered abnormal. RESULTS: Cases had mean duration of hypertension 5 years, mean age of 40 years, and poor blood pressure control (systolic blood pressure >140 and diastolic blood pressure >90 mm of Hg). Newly diagnosed hypertensives had significantly higher QTc values than the matched known cases (0.44 vs. 0.42 s, P < 0.05). Known hypertensives did not differ significantly in QTc values by the duration of disease. CCB users showed small, insignificant disadvantage for abnormally prolonged QTc values than ACEI users. With coexisting diabetes, smoking, and positive family history of hypertension, there was odds risk of 7.69, 2.75, and 2.54, respectively for prolonged QTc. CONCLUSION: Our study showed prolonged QTc in hypertensives more so in newly diagnosed, unaffected by duration or use of ACEI, or CCB but associated with modifiable risk factors. This underscores high risk of repolarization abnormality-induced future events, suggesting early screening of hypertension, strict blood pressure control, optimum use of QTc measurement, and preventive pharmacotherapy to reduce this aftermath.

Study of computerized spirometric parameters of traffic police personnel of Saurashtra region, Gujarat, India.

BACKGROUND AND OBJECTIVES: Air pollution due to road traffic is a serious health hazard and air quality crisis in cities is mainly due to vehicular emission. Thus the persons who are continuously exposed are at an increased risk. The study was carried out to evaluate the extent of impairment in lung function in traffic police personnel compared to matched unexposed control group. MATERIALS AND METHODS: A cross-sectional study was conducted to measure the spirometric parameters of 100 traffic police personnel, aged 20-55 years, working in Saurashtra region, as compared to matched control group, consisting of 100 unexposed males. Measurement of lung volumes and capacities was done with SPIROEXCEL. The statistical analysis was carried out with Graph pad instat 3. RESULTS: Traffic police personnel had significantly declined forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), slow vital capacity (SVC) and maximum voluntary ventilation (MVV) when compared with predictive normal values, which is probably due to exposure to vehicular exhaust. Comparison of test values between groups showed significantly reduced FVC, MVV and increased FEV1/FVC ratio and insignificantly declined FEV1 and SVC in cases as compared to controls. Traffic personnel with longer duration of exposure showed significantly reduced lung functions than those with shorter duration. Smokers showed lower test values as compared to non-smokers with significance only in unexposed group. CONCLUSION: The effect of pollution by vehicular exhausts may be responsible for these pulmonary function impairments and traffic police personnel should be offered personal protective or preventive measures.

Body Composition in Type 2 Diabetes: Change in Quality and not Just Quantity that Matters.

BACKGROUND: Deranged body fat and muscle mass are aftermaths of uncontrolled diabetes. Anthropometric methods like body mass index (BMI) do not give qualitative inferences like total body fat (TBF), visceral fat (VF) or subcutaneous fat (SF) that can be given by bio-electrical impedance analysis (BIA). We studied body composition of type 2 diabetics in comparison to controls matched by age-sex, weight and BMI separately. METHODS: Seventy-eight under-treatment type 2 diabetics of either sex with known glycemic and lipidemic control and equal number of controls with three patterns of matching were taken from our city. We derived parameters of body composition in both groups by Omron Karada Scan (Model HBF-510, China), using the principle of tetra poplar BIA and compared them for statistical significance. RESULTS: We found significantly more SF (30.47% ± 7.73%), VF (11.94% ± 4.97%) and TBF (33.96% ± 6.07%) and significantly lesser skeletal muscle mass (23.39% ± 4.49%) in type 2 diabetics as compared to controls, persisting even after matching with weight or BMI. On assessing qualitatively, the risk of high VF, high TBF, low skeletal muscle mass was significantly high in type 2 diabetics, which were 10.41, 3.01, 9.21 respectively for comparable BMI and 6.78, 3.51, 11.93 respectively for comparable weight. CONCLUSIONS: BIA reveals that type 2 diabetics have more ectopic fat on the expense of skeletal muscle that persists even after matching by weight or BMI, both quantitatively and qualitatively. Measurement of body composition can be included as a primary care strategy to motivate lifestyle modifications while managing metabolic derangements of type 2 diabetes.

A Study of Prevalence and Association of Risk Factors for Diabetic Vasculopathy in an Urban Area of Gujarat.

BACKGROUND: Peripheral arterial disease (PAD) is an aftermath of type 2 diabetes posing a significant health problem in developing countries. Its silent progression warrants presymptomatic screening by ankle brachial index (ABI), which cannot be applied to the whole population. We tried to measure the burden of PAD in diabetics of this region correlating various risk factors for it quantitatively and qualitatively. MATERIALS AND METHODS: From various out-patient departments, 110 known under treatment type 2 diabetics were recruited. They underwent thorough assessment for general, symptomatic, medical history and risk factor screening that included 11 well-known risk factors. ABI was measured by Versadop instrument using the standard protocol with ABI <0.9 being considered as abnormal. RESULTS: There was a high prevalence of asymptomatism, hypertension, positive family history and age <52 years in the study group. Relative risk was highest for asymptomatism followed by high body mass index, hyperlipidemia, cardiovascular disease and smoking, but less significant for age, gender, fasting sugar level, family history. More adverse ABI profile was noticed with the increase in number of five modifiable risk factors cumulatively. CONCLUSION: There was a high prevalence of low ABI in our region that is an evidence of PAD mainly affected by risk factors many of which were modifiable. Defining those who are at risk to develop PAD in Diabetes, one can use ABI better in early screening and prompt treatment of this complication to stop its further progression and primary prevention can be served as felt the need for health-care effectively.