Periodontal disease among non-diabetic Coronary Heart Disease patients. A case-control study.

BACKGROUND: There is well documented scientific evidence supporting the association between Coronary Heart Disease (CHD) and periodontitis. It is however, uncertain if this association is causal or is mediated by the common inflammatory pathways. Hence, the study assessed and compared the Periodontal Health Status among CHD patients with age and gender matched controls. METHODS: A total of 808 medically confirmed CHD patients were compared with 808 age and gender matched controls. Oral examination was conducted using Simplified Oral Hygiene Index (OHI-S) and modified World Health Organization (WHO) Oral Health Assessment form, 1997. Mean scores were compared using Mann- Whitney-U test and Analysis of Variance (ANOVA). Logistic regression analysed the association between the risk factors and CHD. RESULTS: Cases had significantly higher mean sextants with pockets and attachment loss ≥4mm compared to controls (p≤0.05). The cases also had significantly poor oral hygiene mean scores compared to controls (p=0.0001*). There was a lower and insignificant association between age (p=0.99), gender (p=0.84) and CHD. Risk factors education (p=0.001), lesser frequency of dental visit (p=0.001) also showed a lower, yet significant association. Risk of CHD was higher among tobacco (Odds ratio (OR) - 2.26) and alcohol (OR-1.83) users. Presence of poor oral hygiene (OR-5.20), pocket of ≥6 mm (6.70) and attachment loss of ≥9 mm (OR-11.31) also showed higher risk of CHD. CONCLUSION: The study results support the association between periodontal disease and CHD. To halt the epidemic of CHD, emphasis on screening of wide age range, reinforcement of public health systems and early detection is recommended. (www.actabiomedica.it).

Endovascular stenting of IVC using Brockenborough's needle in Budd-Chiari syndrome--a case report.

A young female presented with Budd-Chiari syndrome due to membranous obstruction of inferior vena cava. Membrane was quite thick with complete occlusion of the IVC. She had a previous unsuccessful attempt at endovascular stenting using conventional CTO wire technique. She was successfully treated with balloon angioplasty and stenting after perforation of the thick membrane with Brokenborough's needle. At three months follow-up she was asymptomatic with patent stent.

Associations of -308G/A polymorphism of tumor necrosis factor (TNF)-α gene and serum TNF-α levels with measures of obesity, intra-abdominal and subcutaneous abdominal fat, subclinical inflammation and insulin resistance in Asian Indians in north India.

OBJECTIVES: Obesity is associated with high levels proinflammatory cytokines like tumour necrosis factor alpha (TNF-α), which may play an important role in the genesis of insulin resistance. We evaluated the relationship of -308G/A polymorphism of TNF-α gene with obesity and insulin resistance in Asian Indians in north India. METHODS: This cross-sectional study included 151 apparently healthy individuals (79 males, 72 females) 18-50 yrs of age from New Delhi, India. Body composition by dual-energy x-ray absorptiometry (DEXA) and abdominal fat by magnetic resonance imaging (MRI) were measured. Biochemical measurements included OGTT, lipids, fasting insulin, hs-CRP and TNF-α levels. We analysed -308G/A polymorphism of TNF-α gene and studied its association with obesity and biochemical parameters. RESULTS: At comparable BMI, abdominal obesity was more prevalent in females (50%) as compared to males (20%). The wild genotype (GG) was present in 78.8%, GA in 17.9%, and AA in 3.3% subjects. Measures of body composition, abdominal fat distribution, lipids, insulin, hs-CRP and TNF-α levels were not influenced by the presence of -308G/A polymorphism. Serum TNF-α levels correlated significantly with fasting insulin in both genders. CONCLUSION: TNF-α levels correlate with fasting insulin but not with indicators of body composition in Asian Indians. The -308G/A polymorphism of TNF-α gene is not associated with differences in the serum levels of TNF-α in Asian Indians.

Appropriate values of adiposity and lean body mass indices to detect cardiovascular risk factors in Asian Indians.

OBJECTIVES: The objective of this study was to determine the gender-specific appropriate values of direct measurements of adiposity and lean body mass in Asian Indians. METHODS: Data was collected cross-sectionally in 168 healthy urban Asian Indian individuals. Dual-energy X-ray absorptiometry and anthropometry were used to measure various body composition and fat distribution parameters. Blood pressure, serum lipids, fasting blood glucose, and 2-h glucose in an oral glucose tolerance test were used to identify the cardiovascular risk factors. Subjects were classified according to the presence of two or more of these cardiovascular risk factors. RESULTS: Appropriate cutoff values for total body fat (%), fat mass (kg), total lean mass (%), lean mass (kg), and fat free mass (kg) were 25.5, 15.1, 73.7, 46.3, and 48.8 for males and 38.0, 20.3, 59.0, 32.6, and 34.8 for females. Corresponding values for fat arm (%), fat mass arm (kg), fat leg (%), fat mass leg (kg), fat trunk (%), and fat mass trunk (kg) were 19.8, 1.4, 21.9, 4.1, 30.1, and 8.8 for males and 43.3, 3.1, 38.9, 6.9, 38.5, and 9.5 for females. Stepwise logistic regression analysis confirmed the relatively strong and independent association of fat mass trunk in men and fat mass arm in women with the clustering of cardiovascular risk factors. CONCLUSIONS: Gender-specific cutoffs of direct indices of adiposity and lean body mass are presented in this article, which could be used for clinical and research purpose to detect cardiovascular risk and for categorizing obesity and truncal adiposity in urban Asian Indians.

Subcutaneous abdominal adipose tissue is associated with the metabolic syndrome in Asian Indians independent of intra-abdominal and total body fat.

HYPOTHESIS: Subcutaneous abdominal adipose tissue (SCAT) compared with intra-abdominal adipose tissue (IAAT) would be more significantly associated with the metabolic syndrome in Asian Indians. DESIGN: Cross-sectional study. SETTING: Tertiary care medical institution. SUBJECTS: 100 healthy adults without known heart disease or diabetes. INTERVENTIONS: Magnetic resonance imaging to measure cross-sectional areas of abdominal adipose tissue compartments at the L3-L4 intervertebral level. Dual energy x-ray absorptiometry to measure fat percentage (BF%) and lean mass of total body, trunk, legs and arms. RESULTS: Subjects with the metabolic syndrome (n=35) had a significantly higher BF%, SCAT and IAAT than those without it. Both SCAT and IAAT showed a significant correlation with blood pressure and triglycerides. One SD increase in IAAT (odds ratio (OR) 3.43; 95% CI 1.78 to 6.63) or SCAT area (OR 6.35; 95% CI 2.75 to 14.7) was significantly associated with the metabolic syndrome. On comparing them in the same model, SCAT was the only significant factor associated with the metabolic syndrome (OR 4.92; 95% CI, 1.95 to 12.38). In receiver operating characteristic curve analysis, significant areas under the curves (AUC) were noted for IAAT (0.77) and SCAT (0.89). On comparing the equality of AUC by C statistics, SCAT was a more significant predictor of the metabolic syndrome than IAAT (p=0.009). Only SCAT was significantly associated with the metabolic syndrome after adjusting for BF%, lean body mass or trunk lean mass. CONCLUSION: SCAT is a more important predictor of the metabolic syndrome in Asian Indians than IAAT. The significance of SCAT in the pathogenesis of atherosclerosis and diabetes needs to be investigated further in Asian Indians.

Predictive equations for body fat and abdominal fat with DXA and MRI as reference in Asian Indians.

OBJECTIVE: To develop accurate and reliable equations from simple anthropometric parameters that would predict percentage of total body fat (%BF), total abdominal fat (TAF), subcutaneous abdominal adipose tissue (SCAT), and intra-abdominal adipose tissue (IAAT) with a fair degree of accuracy. METHODS AND PROCEDURES: Anthropometry, %BF by dual-energy X-ray absorptiometry (DXA) in 171 healthy subjects (95 men and 76 women) and TAF, IAAT, and SCAT by single slice magnetic resonance imaging (MRI) at L3-4 intervertebral level in 100 healthy subjects were measured. Mean age and BMI were 32.2 years and 22.9 kg/m(2), respectively. Multiple regression analysis was used on the training data set (70%) to develop equations, by taking anthropometric and demographic variables as potential predictors. Predicted equations were applied on validation data set (30%). RESULTS: Multiple regression analysis revealed the best equation for predicting %BF to be: %BF = 42.42 + 0.003 x age (years) + 7.04 x gender (M = 1, F = 2) + 0.42 x triceps skinfold (mm) + 0.29 x waist circumference (cm) + 0.22 [corrected] x weight (kg) - 0.42 x height (cm) (R (2) = 86.4%). The most precise predictive equation for estimating IAAT was: IAAT (mm(2)) = -238.7 + 16.9 x age (years) + 934.18 x gender (M = 1, F = 2) + 578.09 x BMI (kg/m(2)) - 441.06 x hip circumference (cm) + 434.2 x waist circumference (cm) (R (2) = 52.1%). SCAT was best predicted by: SCAT (mm(2)) = -49,376.4 - 17.15 x age (years) + 1,016.5 x gender (M = 1, F = 2) +783.3 x BMI (kg/m(2)) + 466 x hip circumference (cm) (R (2) = 67.1). DISCUSSION: We present predictive equations to quantify body fat and abdominal adipose tissue sub-compartments in healthy Asian Indians. These equations could be used for clinical and research purposes.