Correlation and Comparison of Epicardial Adipose Tissue with Sagittal Abdominal Diameter and Other Anthropometric and Biochemical Variables of Metabolic syndrome.

OBJECTIVE: 1) To determine relation of epicardial adipose tissue (EAT) thickness with sagittal abdominal diameter (SAD) and other anthropometric measurements in metabolic syndrome (MetS). 2) To determine relation of epicardial adipose tissue with biochemical variables of metabolic syndrome. METHODS: Cases were recruited from the patients attending OPD in New Medical College Hospital, Govt. Medical College, Kota, Rajasthan, India between March 2015 to February 2016. Informed consent was obtained from all participants after taking permission from hospital ethical committee. Patients were categorized as cases and controls according to IDF criteria for MetS. We obtained receiver operating characteristic (ROC) curve of EAT for determination of cut-off values. RESULTS: Epicardial adipose tissue thickness had significant positive correlation with fasting blood sugar (r = 0.49), sagittal abdominal diameter(r = 0.48), body mass index (r = 0.47), LDL cholesterol(r = 0.34), waist circumference (r = 0.33), waist hip ratio (r = 0.32), triglycerides (r= 0.31) and total cholesterol (r = 0.29). Epicardial adipose tissue thickness had significant negative correlation to HDL cholesterol (r = -0.34). EAT thickness (cm) was greater in metabolic syndrome cases (0.515 ± 0.07 vs 0.338 ± 0.06; p < 0.0001). Optimal cut off of EAT in metabolic syndrome is 0.425 cm according to ROC curve at which test is 96% sensitive and 83 % specific. CONCLUSIONS: EAT has shown good correlation with SAD and other anthropometric measurements as well as biochemical parameters of metabolic syndrome. Optimal cut off value of EAT to predict metabolic syndrome is 0.425 cm. FBS and Triglycerides are more closely associated with EAT. HDL Cholesterol is better correlated to SAD while LDL cholesterol is best correlated to WC.

A Prospective Study on Utility of Exercise Treadmill Test in Type 2 Diabetes Mellitus Patients.

OBJECTIVE: Primary objective of this study was to access utility of exercise treadmill test in type-2 diabetes mellitus patients for detecting silent myocardial ischaemia and associated risk factors. METHODS: 75 DM-2 cases were enrolled in study of any age attending medical OPD. All cases were gone through detailed history and TMT procedure. RESULTS: There is higher prevalence of SMI in DM-2 patients. TMT positivity for inducible ischaemia in DM-2 patients were associated with increasing age, male sex, higher BMI, hypertension, smoking, alcoholism, microalbuminuria, macroalbuminuria and dyslipidemia. Duration of diabetes increases the development of CAD in diabetic patients. TMT is a safe procedure with no complication. CONCLUSIONS: For detection of silent myocardial ischaemia in diabetic patients TMT has a significant role. Prevalence of silent myocardial ischaemia in DM-2 patients is 37.3%. There is significant correlation between risk factors of CVD and evidence of ischaemia on TMT in diabetic patients. Duration of diabetic state has a strong correlation for inducible ischaemia on TMT. It may be a safer, cheaper, reliable and easily available non-invasive screening tool for earlier detection of CAD in diabetic patients.

Acute Scrotal Edema: An Atypical Manifestation of Dengue.

Acute scrotal edema associated with dengue fever is a rare and self limiting condition resolving in a few days without any complication or sequelae. We report two cases of dengue fever in father and son which presented simultaneously with acute scrotal edema.

Correlation and Comparison of Various Anthropometric Measurements of Body Fat Distribution and Sagittal Abdominal Diameter as a Screening Tool for Cardio Metabolic Risk Factors and Ischaemic Heart Disease in Elderly Population.

OBJECTIVE: Primary objective of this study was to assess utility of sagittal abdominal diameter (SAD) as a cardio vascular risk predictor and compare various anthropometric measurement of body fat distribution in elderly patients. METHOD: Four hundred patients were enrolled in study. Elderly patients more than 60 year of age attending medical OPD, geriatric OPD and suitable indoor patients who were willing to participate in the study were included. RESULT: SAD was significantly higher in patient with ischaemic heart disease (group 1) than patient without ischaemic heart disease (Group 2) (P < 0.001 for male and female). SAD was better than WC to ascertain individual cardio metabolic risk factors in male, especially FBS (Pearson correlation .33 vs. .29), total cholesterol (Pearson correlation .24 vs. .20) as well as LDL cholesterol (Pearson correlation .13 vs. .05), while in female WC and SAD showed equal correlation with individual cardio metabolic risk factors. CONCLUSION: In patient with metabolic syndrome IHD group showed considerably higher mean SAD values. SAD also showed very good correlation with individual cardio metabolic risk factors especially in elderly male, while in female both SAD and.WC were almost equivalent.

Bridging the resource gap: improving value for money in HIV/AIDS treatment.

The world faces both near-term and potentially long-term shortfalls in funding for HIV/AIDS care and treatment. We review the current funding environment, then discuss a range of opportunities to optimize spending on HIV/AIDS. These include (but are not limited to) more use of specific technologies, such as fixed-dose combination drugs or new diagnostics, as well as investments that strengthen underlying health systems, such as expanding training enrollment of health care providers. We also examine the potential cost impact of these opportunities in a hypothetical country. Combined, these approaches can reduce the cost of treatment while preserving and in some cases improving quality.

Forecast of demand for antiretroviral drugs in low and middle-income countries: 2007-2008.

BACKGROUND: Middle and low-income countries have scaled up HIV treatment in the past 5 years. To maintain this effort, information regarding the amounts and types of drugs is needed. Shortages or overstock of active pharmaceutical ingredients make the scale-up efforts more difficult and costly. To inform global planning and implementation, we estimate the volume of current and future demand for active pharmaceutical ingredients for first and second-line antiretroviral drugs. METHODS: Using regression analysis and documented assumptions, we estimated the number of individuals receiving antiretroviral drugs to 2008. The volume of active pharmaceutical ingredients was calculated using two methods: a normative approach modelling implementation of country-specific guidelines, and an empirical model projecting current trends in drug use estimated by a survey of country HIV programmes. RESULTS: The number of patients treated was estimated to reach 3.38 million by the end of 2008, of which 94.6% would be on first-line and 5.4% on second-line treatment. The largest estimated absolute demand volumes for 2008 were for nevirapine, lamivudine, and zidovudine using either approach; the largest proportional increases in 2007-2008, were observed for emtricitabine, tenofovir, indinavir, and nelfinavir. The gap between normative and empirical estimates was greatest (most positive) for tenofovir, zidovudine, didanosine, and smallest (most negative) for saquinavir and nelfinavir. CONCLUSION: A comparison of the results from the normative and empirical demand quantities suggests that more tenofovir, zidovudine and didanosine would be required if national treatment guidelines were fully implemented, whereas the countries seem to be using more saquinavir and nelfinavir than would be required by their current guidelines.

Chemopreventive potential of Tribulus terrestris against 7,12- dimethylbenz (a) anthracene induced skin papillomagenesis in mice.

In the present investigation, the chemopreventive potential of aqueous extracts of the root and fruit of Tribulus terrestris (an Ayurvedic medicinal plant) on 7, 12 - dimethylbenz (a) anthracene (DMBA) induced papillomagenesis in male Swiss albino mice was studied. A significant reduction in tumor incidence, tumor burden and cumulative number of papillomas was observed, along with a significant increase in average latent period in mice treated orally with Tribulus terrestris suspension continuously at pre, peri and post-initiation stages of papillomagenesis as compared to the control group treated with DMBA and croton oil alone. Treatment with Tribulus terrestris suspension by oral gavage for 7 days resulted in a significant increase in the reduced glutathione content in the liver (P< 0.001 for both root and fruit extracts). Conversely, lipid peroxidation levels were significantly decreased (P< 0.001).

Anticancer and antimutagenic properties of Acacia nilotica (Linn.) on 7,12-dimethylbenz(a)anthracene-induced skin papillomagenesis in Swiss albino mice.

We report the chemopreventive activity of Acacia nilotica (Linn.) gum, flower and leaf aqueous extracts, on 7,12-dimethylbenz(a)anthracene (DMBA) induced skin papillomagenesis in male Swiss albino mice. Animals were divided into following groups: Group I (Controls) given DMBA and croton oil, with no extract ; Group II (treatment) animals treated with Acacia nilotica gum (Group II-a) (800 mg/kg body weight), flowers (Group II-b) (800 mg/kg body weight), or leaves (Group II-c) (800 mg/kg body weight) during the peri- and post initiation periods of DMBA and croton oil application. A significant reduction in the values of tumor burden, tumor incidence and cumulative number of papillomas was observed in mice treated by oral gavage with the Acacia nilotica gum, flower and leaf extracts as compared with the control group. The latency period in treatment Group-II (b) and Group-II (c) was significantly increased as compared with the control group. A significant reduction in the frequency of micronuclei was also observed in mice treated by oral gavage with the aqueous extracts, along with significant decrease in total chromosomal aberrations in the form of chromatid breaks, chromosome breaks, centric rings, dicentrics, acentric fragments and exchange. Treatment with Acacia nilotica flower (Group II-B) and leaf (Group II-C) aqueous extracts by oral gavage for 15 days resulted in a highly significant decrease in the lipid peroxidation (LPO) level in the liver, but this was less evident with the gum (Group II-A) . Conversely, reduced glutathione (GSH) content was observed to be significantly elevated as compared with the control group with leaves (Group II-C) and flowers (Group II-B). The chemopreventive and antimutagenic activity of the leaf extract of Acacia nilotica was most significant followed by the flower extract and then by gum.