A Case-Control Study Utilizing Red Cell Distribution Width as a Bio-Inflammatory Marker in Pre-eclampsia.

INTRODUCTION: This research was conducted to assess the effectiveness of red cell distribution width (RDW) as an indicator for pre-eclampsia (PE), a condition characterized by elevated blood pressure and the presence of protein in the urine occurring beyond the 20th week of pregnancy. METHODOLOGY: The case-control investigation spanned 10 months, following the acquisition of informed consent and the receipt of ethical clearance. The study sample comprised a total of 70 pregnant women, evenly divided into two groups: 35 cases of PE and 35 normotensive pregnant controls. Both the cases and controls provided 3 ml venous blood samples. The study employed a semi-automated three-part hematological analyzer to establish the baseline RDW for all individuals. RESULTS: This study showed that the individuals with pre-eclampsia had a greater RDW compared to the healthy pregnant women. The observed difference was found to be statistically significant, with a p-value of 0.004. The receiver operating curve (ROC) analysis showed that RDW exhibited significant diagnostic accuracy in differentiating between cases and controls (area under the curve [AUC] = 0.71, P = 0.004) when employing a cut-off value of >= 18.25. The sensitivity was 80% and the specificity was 71.4%. CONCLUSION: In contrast to other indicators of inflammation, RDW is a cost-effective and easily accessible biomarker that can be acquired from routine complete blood counts. It has the potential to be valuable in predicting and diagnosing pre-eclampsia.

Plasma Levels of Organochlorine Pesticides and Tumor Necrosis Factor-Alpha: A Potential Risk Factor for Developing Acquired Aplastic Anemia in the North Indian Population.

Background Pesticide exposure might have a contributory role in the development of acquired aplastic anemia (AA). However, the precise mechanisms of pesticide-induced AA remain unknown. In this case-control study, we conducted a comparative analysis of plasma levels of organochlorine pesticides (OCP) and tumor necrosis factor-alpha (TNF-alpha) between Indian patients diagnosed with AA and an age- and sex-matched control group. Methods This is an observational case-control study conducted at a tertiary care hospital in North India. In this study, 90 subjects were included, out of which 45 were diagnosed with AA according to the criteria of the International Agranulocytosis and Aplastic Anemia Study. Cases were compared with 45 controls. A trained interviewer gave all study subjects a questionnaire to collect data regarding demographic details, exposure to pesticides, and clinical history. Physical examination and routine laboratory investigations of each subject were performed. Both cases and controls were tested for their plasma levels of organochlorines as per established protocol by gas chromatography-mass spectrometry. TNF-alpha level was measured by enzyme-linked immunosorbent assay in each subject. Results There was a significant increase in plasma levels of delta hexachlorocyclohexane (delta HCH) (p = 0.02) and heptachlor (p = 0.00) in patients with AA as compared to controls. We observed nonsignificant trends towards higher levels of beta HCH (p = 0.643), aldrin (p = 0.399), and p,p'-Dichlorodiphenyltrichloroethane (p,p'-DDT) (p = 0.453) in patients with AA when compared to the controls. There were significantly higher TNF-alpha levels (p = 0.024) in cases as compared to the controls. Conclusion Our study concludes that patients with AA exhibited higher levels of delta-HCH, heptachlor, and TNF-alpha in comparison to the control group. There is a significant positive correlation of TNF alpha with OCPs (alpha HCH, lindane, delta HCH, heptachlor, aldrin, p,p'- DDD, and methoxychlor pesticides). These organochlorines may have accumulated in the fatty tissue of bone marrow because of their lipophilic nature. This suggests that they might have served as a neoantigen to trigger an increase in TNF-alpha production, which may have led to disrupted bone marrow function through cell-mediated immunity, leading to AA.

Comparison of frequency domain parameters of heart rate variability between women with polycystic ovarian disease and apparently healthy women.

Background: Polycystic ovary syndrome (PCOS) patients shows common features like increased insulin resistance and adiposity, which have been known to correlate with sympathetic hyperactivity. Objective: The aim of this study is to analyze the characteristics of heart rate variability in women with PCOS. To compare frequency domain parameters of heart rate variability (HRV) between women with PCOS and apparently healthy women. To study the impact of cardiometabolic parameters such as BMI and blood pressure on frequency-domain HRV parameters. Methods: A total of 30 women with PCOS aged 20 to 40 years (as per Rotterdam criteria) were enrolled as cases and 30 age-matched women having normal ovulatory cycles were enrolled as controls. HRV was recorded using an electrocardiography machine (ECG) machine. The following frequency-domain parameters were assessed: Total power, Very low frequency (VLF), VLF%, Low Frequency (LF), LF%, LF nu, High frequency (HF), HF%, HF nu, LF/HF ratio, short-term variability (SD1), and long-term variability (SD2), respectively. Results: Mean age of cases was 28.03 ± 5.33 years. Mean BMI of PCOS women was 25.39 ± 2.69 kg/m2. A total of 18 (60%) had BMI >25 kg/m2. Cases had significantly higher BMI, waist hip ratio, and blood pressure as compared with controls. None of the controls had BMI >25 kg/m2. Majority of cases (66.7%) had systolic blood pressure/diastolic blood pressure (SBP/DBP) >130/85 mmHg as compared with only 6 (20%) of controls (P < 0.001). For different frequency domain parameters, no statistically significant difference between two groups was observed for VLF and LF. Mean VLF%, LF%, LF (nu), and LF/HF were significantly higher in cases as compared with controls. For all, the other mean value was significantly lower in cases as compared with that of controls (P < 0.05). Conclusions: Autonomic nervous system is affected by PCOS status of women, and sympathetic hyperactivity is seen.

Association of sleep duration and sleep quality with body mass index among young adults.

Background: It is evident from the research in recent years that short sleep has been found as a risk factor for obesity. However, we still need enough evidence in this field. Therefore, we explored the directionality of the association between sleep duration and sleep quality with body mass index (BMI). Aims: The aim of this study is to evaluate the association of sleep duration and sleep quality with BMI among young adults. Objectives: (a) To assess the association of sleep duration with BMI. (b) To assess the quality of sleep with BMI. Methods: In this cross-sectional study, 88 individuals selected from King George's Medical University were taken as participants. Majority of patients were males (67%). There were 29 (33.0%) females. Sex ratio of study was 2.03, and we used Pittsburgh sleep quality index (PSQI) questionnaire to assess time spent in bed and sleep quality. BMI was divided into 3 categories. Underweight (BMI <18.5 kg/m2), normal weight (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese grade I (25-34.9 kg/m2), obese grade II (35.0 kg/m2), and above. Results: We observed that short sleep duration ± SD (h) <6 h/day f = 9.04; P < 0.001 is associated with greater chances of being overweight and obese and mean sleep quality (mean PSQI ± SD) f = 12.24; P < 0.001 was poor in obese grade I and II. Mean neck and waist circumference also showed a significant increasing trend with increasing BMI category (P < 0.001). Conclusion: This study concludes that short sleep duration and poor sleep quality were associated with overweight obesity among young adults.

Micro (mi) RNA and Diabetic Retinopathy.

Diabetic Retinopathy (DR), a debilitating microvascular complication of diabetes, is one of the leading cause of blindness. However, the pathogenesis of this disease is not fully understood. Few Studies have reported the role of MicroRNA (miRNA), which is deregulated or altered in many diseases. Further, few pathways linked genes which have been suggested to be regulated by miRNAs, may play an important role in the regulation of glucose homeostasis and eventually may contribute to the establishment of DR. However, the roles of microRNAs (miRNAs) in DR are still not very clear. In current review, we explored various findings of scientific database demonstrating the role of miRNA in the progression and development of Diabetic Retinopathy.

Sampling rate influences measures of blood pressure variability in ambulatory blood pressure monitoring.

BACKGROUND: Ambulatory blood pressure monitoring (ABPM) is a valuable tool in the diagnosis and management of hypertension and it is a good predictor of future cardiovascular events. Lack of normal threshold values of ABPM parameters and inconsistency in the sampling rate of recording are hurdles in its wider usage. The aim of the present investigation was to study the influence of sampling rate on ABPM. METHODS: ABPM was performed in 47 healthy subjects and the effect of different sampling rates was studied on ABPM parameters. RESULTS: When data were down-sampled, there was a trend towards decreased concordance and increased dispersion with less frequent recordings. Percent dispersion of MESOR, 24-h average, 24 h standard deviation (SD), awake hours average and sleep hours average of systolic BP (SBP) were around 10% for a sampling interval of 1 h. While average real variability (ARV), morning surge and percent dip in SBP exhibited more than 30% dispersion at a sampling interval of 30 min. CONCLUSION: 24-h average blood pressure (BP) is less sensitive to sampling rate whereas BP variability parameters such as ARV, morning surge and percent dip in SBP are highly sensitive. We suggest that for improving the accuracy of BP variability parameters, a higher sampling rate is desirable around the time of awakening (~2 h before and after the expected time of awakening). At other times, a lower sampling rate may be used for maximizing patient comfort without compromising measurement accuracy.

Leptin DNA Methylation and Its Association with Metabolic Risk Factors in a Northwest Indian Obese Population.

BACKGROUND: It is well established that obesity is a major health risk in diabetes and associated diseases. Epigenetic changes, specially DNA methylation, play an important role in regulation of adipokines. The objective of the present study was to evaluate the DNA methylation status at the promoter region of the leptin gene in obese individuals and its association with metabolic risk factors. METHODS: The study included obese (n=100) and non-obese (n=75) individuals aged 25-45 years, and measured their physical, biochemical parameters (glucose, insulin, and lipid profiles) and leptin, DNA methyltransferase 1 (DNMT1), and DNA methyltransferase 3 beta (DNMT3b) mRNA expressions with real-time reverse transcription-polymerase chain reaction (qRT-PCR). DNA methylation of the leptin gene at the promoter region was analyzed by methyl-specific qPCR . RESULTS: The study found that the DNA methylation level at the promoter area of the leptin gene was negatively associated with weight in obese subjects. Furthermore, study findings showed that the DNA methylation level was negatively associated with fasting insulin, glucose, homeostatic model assessment for insulin resistance, and total cholesterol. There was also a higher expression of DNMT1 and DNMT-3b in obese subjects as compared with non-obese subjects. CONCLUSION: The leptin epigenetic profile may be associated with obesity and its associated metabolic risk factors.

Correlation of obesity indices with heart rate recovery as a marker of autonomic function in healthy young adults.

INTRODUCTION: Obesity has become a challenge for global public health. The global prevalence of obesity has nearly doubled in the past decades (World Health Organization). Obesity may lead to changes in the sympathetic regulation of cardiovascular function, thus favoring the development of cardiovascular complications. AIM: To find a correlation between various obesity indices (body mass index, waist-height ratio, waist circumference and waist-hip ratio) and heart rate recovery in healthy subjects. MATERIALS AND METHODS: A total of 100 apparently healthy subjects aged 18-30 years were enrolled and were divided into two groups on the absence and presence of a family history of cardiovascular disease. The treadmill testing was done in the exercise lab of the physiology department of the medical institute. Exercise testing of the subjects was conducted according to the standard Bruce protocols. RESULTS: There was a negative correlation between various obesity indices and heart rate recovery but we did not get a statistically signification association between them. CONCLUSION: In our study, we have found no statistically significant association between various obesity indices and heart rate recovery. Thus measuring obesity indices in the younger age group will not lead to much significance in terms of heart rate recovery and may be avoided.

Outbreak Trends of Coronavirus Disease-2019 in India: A Prediction.

OBJECTIVE: The objective of this paper is to prepare the government and citizens of India to take or implement the control measures proactively to reduce the impact of coronavirus disease 2019 (COVID-19). METHOD: In this work, the COVID-19 outbreak in India has been predicted based on the pattern of China using a machine learning approach. The model is built to predict the number of confirmed cases, recovered cases, and death cases based on the data available between January 22, 2020, and April 3, 2020. The time series forecasting method is used for prediction models. RESULTS: The COVID-19 effects are predicted to be at peak between the third and fourth weeks of April 2020 in India. This outbreak is predicted to be controlled around the end of May 2020. The total number of predicted confirmed cases of COVID-19 might reach around 68 978, and the number of deaths due to COVID-19 are predicted to be 1557 around April 25, 2020, in India. If this outbreak is not controlled by the end of May 2020, then India will face a severe shortage of hospitals, and it will make this outbreak even worse. CONCLUSION: The COVID-19 pandemic may be controlled if the Government of India takes proactive steps to aggressively implement a lockdown in the country and extend it further. This presented epidemiological model is an effort to predict the future forecast of COVID-19 spread, based on the present scenario, so that the government can frame policy decisions, and necessary actions can be initiated.

Circadian rhythm of airways caliber and its autonomic modulation.

The autonomic nervous system (ANS) is one of the effector pathways for circadian variation of many physiological parameters. Autonomic tone and airways caliber have been reported to exhibit circadian variation in separate studies. A simultaneous investigation of heart rate variability (HRV) and airway caliber might ascertain how airway caliber is modulated by autonomic tone. This study was planned to identify the variations in airway caliber and autonomic function tone during a 24-hour span. A total of 56 healthy male subjects with almost similar daily routines were studied. Time domain, frequency domain and nonlinear analysis of R-R interval from 5 min electrocardiogram (ECG) was done seven times during the daytime wake span at 3-hour intervals starting at 05:00 h in the morning until 23:00 h in the night. Simultaneously peak expiratory flow rate (PEFR) was determined using a mini Wright's peak flow meter. Rhythmometric analysis was done for PEFR and HRV parameters. Significant circadian variation in low frequency (LF) and high frequency (HF) variance was identified in this group of healthy subjects. The circadian rhythm of LF variance was characterized by a gradual increase and corresponding reciprocal change in HF variance from morning until night. The LF/HF ratio and SD2/SD1 ratio reflecting sympatho-vagal balance showed low to high values from morning to evening. The acrophase of the PEFR temporal pattern is similar to that of LF power and almost opposite in phase to that of HF power. PEFR is positively correlated with LF power. The circadian rhythm of airway caliber co-varies with cardiac autonomic tone. It appears that the temporal pattern of cardiac autonomic tone precedes in time that of airways caliber, thereby suggesting the latter operates under the modulatory effect of the 24-hour pattern in sympatho-vagal balance.

Circadian variability in airways characteristics: A spirometric study.

Background: Chronic obstructive pulmonary disease (COPD) and Asthma patients exhibit exacerbation of symptoms in night hours and early morning. Temporal variability in airway caliber have been reported in past using peak expiratory flow rate which represents large airways caliber, while in COPD and Asthma, smaller airways are particularly affected. We studied circadian variability of airway caliber using Forced Expiratory Volume in the First Second (FEV1) and Mid Expiratory Flow rate. Methods: Male volunteers (18-26 years), having similar daily routine were recruited. Spirometry was performed at 5: 00, 8:00, 11:00, 14:00, 17:00, 20:00 and 23:00 h. Data from 104 subjects was analyzed for diurnal variability parameters viz., amplitude percent mean and standard deviation percent of mean. For circadian rhythm Cosinor curve was fitted and rhythm characteristics in terms of MESOR, Amplitude and Acrophase were determined. Results: Repeated measures ANOVA revealed significant differences in spirometric parameters measured at different time points during the day. In general, spirometric parameters follow a sinusoidal pattern and exhibit minimum values during night hours and maximum values during day time. FEV1 Cosinor rhythm was significant in 31% of subjects (Zero amplitude test). The distribution of acrophase revealed interindividual differences in chronophenotypes. Variability was minimum for FEV1% and maximum for FEF75 suggesting dynamic interplay of airway geometry and neuro-chemical influences. Conclusion: The presence of different chronophenotypes in normal subjects suggests that the nocturnal asthma may also be a different phenotype. Availability of portable spirometers and home monitoring thus may be required for ascertaining chronophenotype and tailoring chronotherapeutic interventions.

Sleep quality and insulin resistance in adolescent subjects with different circadian preference: A cross-sectional study.

BACKGROUND: Studies have shown that alterations in the sleep cycle can predispose to several disorders. Most of the previous studies were done on the adults. Hence, the aim of the study was to see the effect of circadian disruption on the health of adolescent population. MATERIALS AND METHODS: In this cross-sectional study, 203 subjects were enrolled. Study subjects were divided into three groups: definite evening chronotype, intermediate chronotype, and definite morning chronotype. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). Daytime sleepiness and chronotype were measured by Epworth Sleepiness Score and Morningness-Eveningness Questionnaire Self-Assessment version, respectively. Two hours postprandial glucose was measured after oral glucose tolerance test. Fasting blood glucose and fasting insulin were measured. Homeostasis model of assessment for insulin resistance (HOMA-IR) was calculated. Data were summarized as mean ± standard deviation. Crude odds ratios and Karl Pearson's correlation coefficient of metabolic parameters with poor sleep were calculated. RESULTS: Statistically significant difference was found in the mean value of poor sleep quality, 2 h postprandial blood glucose level, and insulin resistance among subjects of three groups. Subjects of evening chronotype have more significant positive correlation of 2 h postprandial blood glucose level and HOMA-IR value with poor sleep quality when compared with subjects of intermediate and morning chronotypes. CONCLUSION: Subjects with evening chronotype are more prone for development of metabolic syndrome compared with subjects of intermediate and morning chronotypes if proper health policies are not adopted for adolescents.

Circadian Preference, Sleep Quality, and Health-impairing Lifestyles Among Undergraduates of Medical University.

Background/Aims Health-impairing lifestyle during adolescence is an important marker for poor health. An unhealthy lifestyle may lead to physical and psychological problems in adulthood. Most of the prior researches were done among the adult population. Therefore, we assessed the chronotype pattern and correlation of health-impairing lifestyles with sleep quality according to circadian typology in medical students. Material and Methods In this cross-sectional research, a total of 203 subjects were enrolled. All subjects were divided into definite evening chronotype (n = 73), intermediate chronotype (n = 87), and definite morning chronotype (n = 43). Electronic media use at bedtime and duration of media use, the timing of dinner, smoking, tobacco chewing, and alcohol consumption were assessed with the help of a preformed proforma. Physical activity, sleep quality, daytime sleepiness, and chronotype were assessed by International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Score (ESS), and Morningness-Eveningness Questionnaire Self-assessment version (MEQ-SA), respectively. Results Subjects of the evening chronotype were suffering more with poor sleep quality. Evening chronotype had a significant (p < 0.05) positive correlation between poor sleep quality and sex, tobacco smoking, alcohol drinking, type of diet, and timing of dinner. Conclusion Circadian typology demonstrated the significant correlation of health-impairing lifestyles with sleep quality. From this observation, it might be a better way to plan their daily activities, in accordance with their chronotypes, benefiting not only their academic performance but also their quality of life.

Effect of Metaboreflex on Cardiovascular System in Subjects of Metabolic Syndrome.

INTRODUCTION: Metaboreflex is a reflex in which muscle receptors send signals regarding metabolic (metabolites accumulation like lactic acid, potassium, adenosine) conditions of the muscles to nucleus tractus solitarius via afferent III and IV fibres to cause haemodynamic adjustments in order to regulate blood flow on the basis of the status of contracting muscle. Dysregulation in its mechanism in metabolic syndrome is demonstrated. AIM: To study the effect of metaboreflex by both isometric and rhythmic handgrip exercise on CVS parameters {Blood Pressure (BP), Cardiac Output (CO) and Systemic Vascular Resistance (SVR)} in subjects of metabolic syndrome. MATERIALS AND METHODS: In this study, 27 subjects aged 25 to 45 years were enrolled after ethical clearance and proper consent. They were divided into: a) subjects without metabolic syndrome; and b) subjects with metabolic syndrome. Impedance cardiovasography was done to assess cardiac parameters (systolic and diastolic blood pressure, cardiac output, systemic vascular resistance). Pre-exercise parameters were assessed followed by isometric exercise and post-isometric exercise parameter measurement. Again after rest, rhythmic exercise was followed. Finally post exercise parameters were assessed. Student paired t-test for comparison between pre and post exercise parameters were done. RESULTS: Changes in diastolic BP following exercise were statistically significant in subjects without metabolic syndrome (p-value 0.01 and 0.001 following isometric and rhythmic exercise respectively). In subjects with metabolic syndrome also these changes were significant, but to a lesser extent (p-value 0.1 and 0.01 respectively for isometric and rhythmic exercise). Changes in systolic BP following exercise were statistically significant in subjects without metabolic syndrome (p-value 0.001 and 0.001 following isometric and rhythmic exercise respectively). In subjects with metabolic syndrome also these changes were significant (p-value 0.01 and 0.001 respectively for isometric and rhythmic exercise). CONCLUSION: Diminished pressor response is found after exercise in subjects with metabolic syndrome.

Cardiovascular Response and Serum Interleukin-6 Level in Concentric Vs. Eccentric Exercise.

INTRODUCTION: Cardiovascular Disease (CVD) is a leading cause of morbidity and mortality in India. Resistance exercise is strongly recommended for implementation in CVD prevention programs. Dynamic resistance exercise comprises of concentric (muscle shortening) and eccentric (muscle lengthening) phase. The contraction of skeletal muscle promotes the synthesis and secretion of cytokines and peptides from myocytes, known as 'myokines'. Interleukin-6 (IL-6) is the first myokine to be released in the blood in response to exercise. AIM: To compare the cardiovascular response and serum IL-6 level in concentric and eccentric exercise done at same absolute workload. MATERIALS AND METHODS: In this non-randomised crossover study 24, apparently healthy and young male adults performed an acute bout of concentric and eccentric exercise. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Heart Rate (HR), Mean Arterial Pressure (MAP), Pulse Pressure (PP) and serum IL-6 were measured just before and immediately after exercise. Paired t-test or Wilcoxon signed-rank test were applied to compare the data within-group and in-between group. RESULTS: SBP, HR, MAP, PP, DBP and IL-6 level increased significantly after both, concentric and eccentric exercise. The mean change in SBP, HR, MAP, PP, and IL-6 after concentric exercise (18.54±3.06, 57.21±10.73, 8.35±1.40, 15.25±5.29, 5.40±3.13 respectively) was significantly higher than after eccentric exercise (13.38±1.72, 43.25±8.34, 6.50±1.0, 10.21±3.16, 4.36±2.54 respectively). A non-significant rise in DBP was obtained after concentric exercise (3.25±2.79) as compared to eccentric exercise (3.08±1.89). CONCLUSION: Eccentric exercise not only caused a lesser cardiovascular demand as compared to concentric exercise but also a significant increment in IL-6 level. Exercise-induced IL-6 may prevent the initiation and development of CVD. Hence, eccentric exercise training might be recommended for reducing morbidity and mortality in individuals with- or at a risk of developing CVD.

Effect of Recumbent Body Positions on Dynamic Lung Function Parameters in Healthy Young Subjects.

INTRODUCTION: The change in body position can alter pulmonary functions parameters, therefore it is important to understand the physiological basis of these alteration. Ideally, spirometry is done in sitting position until the subject is unable to do so. Hospitalized patients often assume recumbent body positions irrespective of underlying pathology. Hence, need arises to find out best recumbent body positions for the benefit of these patients to make breathing comfortable for them. AIM: The aim of this study was to find out whether the change from the supine position to crook lying and Fowler's position (45° dorsal elevation) causes change in spirometric parameters. MATERIALS AND METHODS: The present work was carried out at Department of Physiology, King George's Medical University, Lucknow. A total 131 apparently healthy individuals were enrolled in this cross-sectional study. Lung function was assessed using a PC-based spirometer according to American Thoracic Society guideline in the supine, crook lying and Fowler's position (45° dorsal elevation). RESULTS: The study consisted of 131 subjects (male 66%, female 34%), with mean age of 20.15±2.71 years and BMI 21.20±3.28 Kg/m2. Repeated measures ANOVA with post hoc Bonferroni test was used to compare the mean values between each body position. Compared with the other two positions, Fowler's position showed significantly (p<0.05) higher values for FVC, FEV1, PEF, FEF25-75%. CONCLUSION: Recumbent body position influences spirometric parameters in young healthy subjects. We demonstrated that spirometric values are higher in the Fowler's position than in the supine or crook lying position. The results of this study will help in the selection of the best alternative position for the spirometry in bed ridden patients.

Cardiovascular sequel of neck irradiation in head and neck cancer patients.

PURPOSE: The baroreflex is an important afferent mechanism controlling autonomic functions. As afferent nerves course through the neck, they are susceptible to damage by neck irradiation in head and neck cancer patients. With increased survival of head and neck cancer patients because of improved therapy, the cardiovascular morbidity and mortality in them have become apparent and this is of clinical concern. There are few case reports of baroreflex failure as a chronic sequel to neck irradiation. OBJECTIVES: The present study evaluated the changes in cardio-autonomic tone and postural cardiovascular reflex in neck-irradiated patients. METHODS: Head and neck cancer patients who had received neck irradiation (n = 15) and healthy controls (n = 15) were evaluated for heart rate variability with time domain analysis of 5 min ECG recording. Postural cardiovascular reflexes were studied with changes in blood pressure and heart rate in the lying to standing test. RESULTS: Our results suggest that there is a reduction in overall time domain measures of heart rate variability and weakened postural reflexes in neck-irradiated patients. CONCLUSION: Decreased heart rate variability in neck-irradiated patients reflects an independent risk of cardiovascular morbidity. The early detection of cardiovascular impairment in such patients may help healthcare professionals in providing better care. Furthermore, the dose delivered to the carotid sinus should be monitored and restricted.

Antiproliferative and Apoptotic Effect of Curcumin and TRAIL (TNF Related Apoptosis inducing Ligand) in Chronic Myeloid Leukaemic Cells.

INTRODUCTION: Curcumin, traditionally utilized as a flavouring zest as a part of Indian cooking, has been accounted to decrease the proliferation potential of most cancer cells. Apoptosis is a mechanism by which most anticancer therapies including chemotherapy, radiation and antihormonal therapy kill tumour/cancer cells. Novel agents that may sensitize drug-resistant tumour cells for induction of apoptosis by customary treatments could lead to the regression and improved prognosis of the refractory disease. Indeed, chemotherapeutic agents have been shown to sensitize cancer cells to killing by death ligands such as tumour necrosis factor-α. AIM: To investigate cytotoxicity and apoptotic effect of curcumin in chronic myeloid leukaemic cell line KCL-22. MATERIALS AND METHODS: In present study, different doses of curcumin (10,25,50,75,100µM) and tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) (25,50 µM) alone and combine regimen were exposed to myeloid leukaemic cell KCL-22. The cell viability was monitored by MTT assay, apoptotic activity by binding of Annexin V-FITC using fluorescence microscopy and cell cycle check points by flow cytometry. RESULTS: Cytotoxic assay revealed that curcumin and TRAIL induced both dose and time-dependent decrease in cell viability. Significant cell cytotoxicity was seen in combine regimen of both curcumin and TRAIL at 48 h of exposure. Cells treated with curcumin and TRAIL was arrested at the S phase, as revealed by flow cytometric analysis. Subtoxic concentrations of the curcumin-TRAIL combination induced strong apoptotic response in KCL-22 cells as demonstrated by the binding of Annexin V-FITC. CONCLUSION: Our study conclude that curcumin inhibits the cancer cell growth by inducing apoptosis and enhance the therapeutic potential of TRAIL which recommends that both curcumin alone or in combination with TRAIL might be useful for leukaemic prevention and better therapeutic responses.

Cardiac Output Assessment by Transthoracic Electrical Bio-impedance in Patients of Acute Myocardial Infarction: Comparative Analysis with Echocardiography.

Objectives: Transthoracic electrical bio-impedance (TEB) has been proposed as a non-invasive and continuous method of cardiac output (CO) measurement, but it still has not found wide usages in clinics. The present study measured CO, using a new instrument NICOMON, and compared it with Echocardiography (ECHO) in acute myocardial infarction (AMI) patients. Methods: In the present study 100 patients of AMI were assessed by both ECHO and NICOMON for cardiac output and ECHO is considered as a reference method for comparison. TEB CO was measured by passing an alternating current and measuring the bio-impedance across the thorax. End diastolic volume (EDV), End systolic volume (ESV) & Left ventricular outflow tract (LVOT) diameter, measured by ECHO were used to calculate CO. Various statistical methods like "t"-test & correlation coefficient (r) were used where found suitable. Results: Results: Mean TEB-CO (4.03±1.11 l/min) was significantly higher (p<0.001) than mean ECHO-CO (3.80±1.28 l/min) with a mean difference of 0.25±1.02 l/min. Conclusions: NICOMON measures CO non-invasively but, it needs more elaborative studies on a larger sample to establish it as an alternative method of ECHO for cardiac output measurement on regular basis.

Role of Vitamin-D in the prevention and treatment of Alzheimer's disease.

Alzheimer's disease is the most common form of age related cognitive impairment. Aim of the present study was to see the effect of vitamin D on cognitive function in elderly. The study was conducted in Department of Physiology, King George's Medical University (KGMU). A total of 80 subjects were enrolled based on Mini Mental State Examination (MMSE) score < 24 and vitamin D deficiency. They were divided into two groups as Group A (case) and Group B (control), each group having 40 subjects. Intervention (Vitamin D supplementation) was given in Group A. The assessment of dementia was done by Mini Mental State Examination (MMSE) score. Every subject was clinically evaluated and estimation of vitamin D was done by direct ELISA kit. Gender, weight, height, BMI, residence and education were also similar between two groups. A significant (p=0.0001) change in MMSE score was observed in both Group A and Group B from baseline to 3 & 6 months and from 3 to 6 months, however, mean change was higher in Group A than Group B. In conclusion, vitamin D supplementation caused significant improvement in the cognitive performance in subjects with senile dementia.