The distance between the lower edge of the xiphisternum and the center of the umbilicus as an indicator of abdominal obesity and cardiovascular disease risk.

OBJECTIVE: Abdominal obesity is considered an independent risk factor for cardiovascular disease (CVD). AIM: To compare the distance between the lower edge of xiphisternum and the center of the umbilicus (XUD) with other anthropometric measurements in predicting risk factors for CVD. METHODS: A random sample of 4,485 (males 1,772, females 2,713) nationally representative noninstitutionalized adults aged >or=18 years were included in the analysis. XUD, BMI, waist circumference (WC), waist-to-hip ratio (WHR), systolic and diastolic blood pressure were measured and fasting venous blood samples were collected to determine glucose, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein cholesterol and triacylglyceride levels. Oral glucose tolerance test (OGTT) was also preformed. RESULTS: The mean XUD (+/- SD) was 17.4 +/- 3.2 cm and 17.0 +/- 3.0 cm for males (M) and females (F) respectively (M vs. F; p < 0.001). XUD had significant correlations with the cardiovascular risk factors analyzed as continuous variables (p < 0.001), except LDL cholesterol for women. However, the strengths of associations were weak for all associations (<0.3). The correlations of BMI, WC and WHR with XUD were significant (p < 0.001). The area under the curve (AUC) in the receiver operating characteristic (ROC) curve analysis for XUD in predicting the presence of two or more CVD risk factors was 0.62 (95%CI 0.61- 0.64); the corresponding AUC values for BMI (0.71, 95% CI 0.69-0.72), WC (0.71 95% CI, 0.70-0.73), and WHR (0.67 95% CI, 0.65-0.68) were higher than that for XUD. CONCLUSION: The XUD showed significant correlations with the cardiovascular risk factors among Sriii Lankan adults. However, in predicting CVD risk XUD was inferior to BMI, WC, and WHR.

Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial.

BACKGROUND: Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit. METHODS AND FINDINGS: We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised to receive pralidoxime (121) or saline placebo (114). Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8%) receiving pralidoxime died, compared with 18/114 (15.8%) receiving placebo (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 0.88-3.26, p = 0.12). Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. The need for intubation was similar in both groups (pralidoxime 26/121 [21.5%], placebo 24/114 [21.1%], adjusted HR 1.27 [95% CI 0.71-2.29]). To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit. CONCLUSIONS: Despite clear reactivation of red cell acetylcholinesterase in diethyl organophosphorus pesticide poisoned patients, we found no evidence that this regimen improves survival or reduces need for intubation in patients with organophosphorus insecticide poisoning. The reason for this failure to benefit patients was not apparent. Further studies of different dose regimens or different oximes are required.