A Cross-sectional Study of Anatomical Variations of Coronary Ostia in the Adult Human Hearts and its Clinical Significance

Introduction: The knowledge of anatomical variations of the coronary ostia is an important factor in the study of Coronary Heart Disease (CHD). With the adaptation of sedentary life style and increasing stress, CHD has become the major cause of death in many countries. Aim: To describe the location, size and shape of the coronary ostia in cadaveric hearts. Materials and Methods: Descriptive cross-sectional study was carried out in 110 adult human hearts, 90 males and 20 females with a mean age of 66 years, which were collected from the mortuary from March 2017 to March 2019. The aorta was dissected and the aortic sinuses were opened, the number, location, size, shape and anomalous presence of accessory coronary ostia was noted and the measurements were taken using vernier calipers. Results: The Right Coronary Artery (RCA) was seen taking origin from the anterior aortic sinus and the Left Coronary Artery (LCA) from the left posterior aortic sinus in all the 110 hearts. The mean diameter of the Left Coronary Ostia (LCO) was 3.66±0.40 mm and found to be greater than the Right Coronary Ostia (RCO) 3.43±0.38 mm. Variations in the location and shape of the RCO and LCO were noted, and presence of single accessory coronary ostia was observed in five cases. Presence of multiple accessory coronary ostia was observed in only one case and its presence was found to be very rare. Conclusion: The diameter of the LCO was found to be greater than the RCO and the shape was circular in most of the coronary ostia. The majority of the coronary ostia were found to be located within the aortic sinuses below the Sinutubular Junction (STJ). Anatomical knowledge of the coronary ostia in the ascending aorta is very important during cardiac interventions around the aortic root

Correlation of abdominal adiposity with components of metabolic syndrome, anthropometric parameters and Insulin resistance, in obese and non obese, diabetics and non diabetics: A cross sectional observational study. (Mysore Visceral Adiposity in Diabetes Study)

Objectives : To measure Visceral Fat (VF) and Subcutaneous Fat (SCF) by ultrasound, in obese and non-obese diabetics and obese and non-obese non diabetics, in a South Indian (Asian Indian) Population and correlate them with Body Mass Index (BMI), Waist Circumference (WC), components of metabolic syndrome and Insulin Resistance (IR) Research Design and Methods: This was a prospective observational study, 80 diabetics (40 obese and 40 non obese) and 80 non diabetics (40 obese and 40 non obese) a total of 160 subjects were enrolled, out of whom 153 completed the study. The subjects were evaluated with respect to BMI, WC, Blood Pressure (BP); Fasting Blood Sugar (FBS) Fasting Insulin levels (FIL), HbA1C and Lipid profile.The SCF and VF were measured by Ultrasonography.The results were statistically analyzed. Results: WC correlated significantly with VF in all the groups. Diabetics had more VF compared to non-diabetics. Insulin resistance was significant in all the groups; however diabetics had greater levels of IR, BMI, WC, VF and SCF had no correlation with IR and had no significant correlation with metabolic parameters. Conclusions: In this study population, WC was found to be a useful surrogate measure of VF conforming to its well established applicability in other populations. Contrary to other studies elsewhere, SCF and VF were found to be poor indicators of Insulin Resistance. BMI, WC, VF and SCF were not useful in the prediction of metabolic syndrome. Ultrasound was found to be an easier and economic method of measuring abdominal adiposity and actual measurement of abdominal fat was more informative than anthropometric measurements

Occurrence of diabetes mellitus in obese nondiabetic patients, with correlative analysis of visceral fat, fasting insulin, and insulin resistance: A 3-year follow-up study (mysore visceral adiposity in diabetes follow-up study)

Objective: To assess the occurrence of diabetes in obese nondiabetic patients over a 3-year follow-up period with a correlative analysis of visceral fat (VF), fasting insulin levels, (FILs) and insulin resistance (IR). Material and Methods: Thirty-seven obese and nineteen nonobese nondiabetics of our previous study, Mysore Visceral Adiposity in Diabetes were followed for the next 3 years. Their blood pressure, body mass index, waist circumference (WC), fasting blood sugar (FBS), FIL, lipid profile and subcutaneous fat (SCF), and VF measurement by US method were repeated every 6 months for the next 3 years. The findings were analyzed with appropriate statistical methods. Results: Twenty-three obese and 18 nonobese nondiabetics completed the study. There were 17 dropouts. The changes in the physical and biochemical characteristics of the two groups before and after the study were not significant. SCF had no correlation with IR whereas VF correlated with FIL and IR. There were three diabetics in the obese group and two from the control group at the end of the study. There were 12 impaired glucose tolerance (IGT) in the test group and 2 in the control group. Those who developed diabetes had higher VF, WC, FBS, FIL, and IR. Those who showed IGT also had these at higher levels compared to others. There was no change in the VF at the end of the study. Conclusions: This follow-up study on South Indians has shown that VF is a significant risk factor for the development of IR. IR can develop without any increase in the volume of the VF, is the essential finding of this study. SCF has not shown any significant relationship with IR. We recommend FBS and FIL in all the obese nondiabetics to calculate IR, which has given much insight in the development of IGT and diabetes. Large multicentric, longitudinal studies are required to establish the cause of IR

Frequency and nature of adverse drug reactions in elderly in-patients of two Indian medical college hospitals

Background: Adverse drug reactions (ADRs) are a major public health problem in the elderly. Although the Indian elderly represent 12.8% of the entire global elderly population, data on prevalence and predictors of ADRs in elderly Indians is extremely limited. Aim: To determine the prevalence, severity, preventability, length of hospital stays, and risk factors for ADRs in hospitalized Indian elderly. Setting: Medicine wards of two tertiary care teaching hospitals. Design: Prospective study was conducted between July 2007 and December 2009. Materials and Methods: In-patients of either sex and aged ≥60 years were included and monitored for ADRs throughout their hospital stay. Severity (Hartwig et al. scale), preventability (Shumock and Thornton criteria) and increased length of stay (considering underlying disease, ADR, and discussion with clinicians) were assessed. Statistical Analysis: Bivariate analysis and subsequently multivariate logistic regression were used to determine the risk factors for developing ADRs. Results: Over the study period, among the 920 patients monitored, 296 patients (32.2%) experienced 419 ADRs. Among all ADRs, 48.4% (203) were preventable. Majority of ADRs [226 (53.9%)] were moderate in severity. Therapeutic classes of drugs frequently associated with ADRs were the drugs used in diabetes [76 (18.1%)] and antibacterials for systemic use [54 (12.9%)]. ADRs increased the hospital stay in 5.9% (54) of patients. Female gender [Odds Ratio: 1.52, 95% Confidence Interval:1.04-2.22, P=0.03] was observed as the influential risk factor for ADRs. Conclusion: One third of hospitalized elderly experienced ADRs. Interventions focused at preventable ADRs should be developed and implemented to reduce their implications

Frequency and nature of adverse drug reactions in elderly in-patients of two Indian medical college hospitals

Background : Adverse drug reactions (ADRs) are a major public health problem in the elderly. Although the Indian elderly represent 12.8% of the entire global elderly population, data on prevalence and predictors of ADRs in elderly Indians is extremely limited. Aim : To determine the prevalence, severity, preventability, length of hospital stays, and risk factors for ADRs in hospitalized Indian elderly. Setting : Medicine wards of two tertiary care teaching hospitals. Design : Prospective study was conducted between July 2007 and December 2009. Materials and Methods : In-patients of either sex and aged ≥60 years were included and monitored for ADRs throughout their hospital stay. Severity (Hartwig et al. scale), preventability (Shumock and Thornton criteria) and increased length of stay (considering underlying disease, ADR, and discussion with clinicians) were assessed. Statistical Analysis : Bivariate analysis and subsequently multivariate logistic regression were used to determine the risk factors for developing ADRs. Results : Over the study period, among the 920 patients monitored, 296 patients (32.2%) experienced 419 ADRs. Among all ADRs, 48.4% (203) were preventable. Majority of ADRs [226 (53.9%)] were moderate in severity. Therapeutic classes of drugs frequently associated with ADRs were the drugs used in diabetes [76 (18.1%)] and antibacterials for systemic use [54 (12.9%)]. ADRs increased the hospital stay in 5.9% (54) of patients. Female gender [Odds Ratio: 1.52, 95% Confidence Interval:1.04-2.22, P=0.03] was observed as the influential risk factor for ADRs. Conclusion : One third of hospitalized elderly experienced ADRs. Interventions focused at preventable ADRs should be developed and implemented to reduce their implications