Abdominal fat distribution and its relationship to sagittal abdominal diameter (SAD) and SAD-height ratio – An analytical cross-sectional study in the South Indian population

Background: The prevalence of obesity is increasing in developing countries like India. This will place a great burden on the health infrastructure of the country. Early identification and intervention are the keys to managing this important problem. Since Asians tend to have more visceral body fat for any given body mass index (BMI), lower cut-off values have been suggested for different anthropometric parameters. Studies determining the correlation of Sagittal abdominal diameter (SAD) and SAD-height ratio (SADHtR) with total visceral fat volumes measured by computed tomography (CT) scan abdomen quantification are limited in the South Indian population. Aims and Objectives: This study was conducted with the objectives of measuring BMI, SAD, SADHtR, and comparing the correlation of the measured anthropometric parameters with visceral and subcutaneous abdominal fat volumes measured using CT scan abdomen in both the genders in South Indian population. Materials and Methods: This analytical cross-sectional study was done in a hospital setting with a sample size of 566 (276 men and 290 women-aged 30–70 years). Weight, height, and BMI were measured. SAD was measured electronically from a CT image at the L4–L5 level. SADHtR was derived. Total abdominal fat volumes, subcutaneous abdominal fat volumes, and visceral abdominal fat volumes were measured in cm3 from the dome of the liver to the pubic symphysis using software for CT-based quantification of fat volumes between ?190 and ?30 Hounsfield units threshold limits. The data were tabulated and analyzed to compare mean values between men and women and to find the correlation between the anthropometric parameters and visceral fat volume using Pearson’s correlation test. Results: The difference in mean values of BMI, SAD, and SADHtR between the sexes was statistically significant. SAD showed the highest correlation with visceral fat volume in both genders. BMI showed a higher correlation with subcutaneous adipose tissue volume than with visceral adipose tissue volume. Conclusion: Both SAD and SADHtR can be used as simple and reproducible anthropometric tools to identify the presence of increased visceral fat volume in both genders in our population.

A Surgeon's Insight on Kala Pareeksha with the Aid of Gurvadi Gunas

The physicians around the world would have come across the patients complaining of a particular symptom arising in a particular time of the day or night, or similar complaints recurring around the same months for the past few years, in their clinical practice. The classical texts of Ayurveda have described Kala as a factor influencing pathogenesis, diagnosis and treatment of a disease. The term “Kala” indicates Rogi avastha as well as the time. Though the texts have given the details of various seasons along with the changes that the Doshas undergo in each of them and the regimens to follow respectively, the description of Dosha avasthas with respect to day and night is very limited. Acharya Sushruta, the father of surgery has given a key insight on this principle. Ayurvedic diagnosis and treatments cannot be standardized in a very broad scale but rather its approach should be target- specific, for which we need deeper analysis for the principles. For achieving this, a Guna based analysis of every aspect of the protocol is to be followed while diagnosing and treating the patient (Guna Pratyaneeka pareeksha and Chikitsa), a process which unearths the hidden secrets of Ayurveda. This article deals the concept of Kala pareeksha in terms of day, night and a season from the basis of Gunas rather than the basis of Doshas with respect to the references from mainly Sushruta Samhita and Ashtanga Hrudaya in a way showing the actual beauty of the ever-puzzling science we are striving to practice.

Role of tissue engineering in oral & maxillofacial surgery – a review

Tissue engineering can be defined as the “reconstitution of tissue and organs, in vitro for use as model systems in basic and applied research, or for use as grafts to replace damaged or diseased body parts or body functions”. Biomaterials have been used as replacement tissues and grafts have been used to reconstruct defects in craniofacial region till Uristmade the first attempt of producing exogenous bone with the help of bone morphogenetic proteins. The success of tissue engineering over the field of all transplantation is that conceptually a three-dimensional functional tissue is designed. This field has become a boon to the Cranio Maxillofacial surgeons and has provided them with a supplement to existing treatment for reconstruction of Oral & Craniofacial region. The purpose of this article is to present an overview of the various uses of tissue engineering in the field of Oral and Maxillofacial Surgery.

Risk factors of female breast carcinoma: A case control study at Puducherry.

Objective: To identify and quantify various demographic, reproductive, socio-economic and dietary risk factors among women with breast cancer. Study Design: Case control study. Study Period: February 2004 to May 2005. Study Setting: Departments of Surgery, Medicine and Radiotherapy of Jawaharlal Institute of Postgraduate Medical Sciences and Research (JIPMER), Pondicherry. Materials and Methods: Cases were women with pathologically confirmed breast cancer. Controls were age-matched women from medicine and surgery wards without any current breast problem or previous breast cancer. A total of 152 cases and 152 controls were enrolled. They were interviewed for parity, breast feeding, past history of benign breast lesion, family history and dietary history with a pre-tested interview schedule after obtaining informed written consent. Results: The significant risk factors were (odds ratios with 95% CI) previous history of biopsy for benign breast lesion 10.4 (1.3-86.3), nulliparity 2.4 (1.14-5.08), consumption of fats more than 30 g/day 2.4 (1.14-5.45) and consumption of oils containing more of saturated fat 2.0 (1.03-4.52). Conclusions: Nulliparity, past history of benign breast lesion, high fat diet and consumption of oils with more saturated fats were the risk factors.

'O' set connector system in CAPD.

51 CAPD patients (age 55.5 +/- 14.5 yrs, 35 male, 16 female) on CAPD using 'O' set were studied retrospectively during the period January 1993 to April 1995. Etiology of ESRD was Diabetic nephropathy-25(49%) and the other causes-26(51%). The total duration of observation on 'O' set was 553 patient months, the mean duration was 10.8 +/- 6.1 months. 24 patients (47%) developed total of 30 episodes of peritonitis. The incidence of peritonitis was 18.4 patient months per episode of peritonitis. The organisms responsible for peritonitis were Gram positive-6(20%), Gram negative-3(10%), Fungal-1(3.3%), Mycobacterial-1(3.3%), Eosinophilic-1(3.3%), Sterile-12(40%) and unknown-6(20%) 2 patients of bacterial peritonitis and a patient with tuberculous peritonitis died while rest of the patients responded favourably to antibiotics. 13(52%) diabetic patients and 11(42%) non-diabetic patients had peritonitis (p-NS) and the peritonitis rates in diabetics and non diabetics were 18.3 and 18.6 patient months per episode respectively (p-NS). Exit site infection was seen in 5 patients (10%) (Staph aureus-4, Enterococci-1) and all responded to antibiotic therapy. 7 patients had total of 10 episodes of symptomatic accidental intraperitoneal sodium hypochlorite instillation, none had any long term adverse effects. The 'O' set procedure was done by self in 10(20%) and by others in 41(80%) cases. The peritonitis rates when performed by self and others were 18.5 and 18.4 patient months per episode respectively (p-NS). The cost of being on CAPD using 'O' set, Y-bag and twin bag were Rs. 1,50,000, 2,10,000 and 3,72,000 per annum respectively and cost of maintenance haemodialysis was 1,36,800 per annum. The cost of CAPD using 'O' set was comparable to that of maintenance haemodialysis. The 'O' set connector system in CAPD is found to be safe, cost effective and efficient.