High Prevalence of Abdominal, Intra-Abdominal and Subcutaneous Adiposity and Clustering of Risk Factors among Urban Asian Indians in North India

OBJECTIVE: To assess the prevalence of abdominal obesity including intra-abdominal and subcutaneous adiposity along with other cardiometabolic risk factors in urban Asian Indians living in New Delhi. METHODS: We conducted a cross-sectional epidemiological descriptive study with 459 subjects (217 males and 242 females), representing all socio-economic strata in New Delhi. The anthropometric profile [body mass index (BMI), waist circumference (WC) and skinfold thickness], fasting blood glucose (FBG) and lipid profile were recorded. Percent body fat (%BF), total abdominal fat (TAF), intra-abdominal adipose tissue (IAAT) and subcutaneous abdominal adipose tissue (SCAT) were quantified using predictive equations for Asian Indians. RESULTS: The overall prevalence of obesity was high [by BMI (>25 kg/m(2)), 50.1%]. The prevalence of abdominal obesity (as assessed by WC) was 68.9%, while that assessed by TAF was 70.8%. Increased IAAT was significantly higher in females (80.6%) as compared to males (56.7%) (p = 0.00) with overall prevalence being 69.3%. The overall prevalence of high SCAT was 67.8%, more in males (69.1%) vs. females (66.5%, p = 0.5). The prevalence of type 2 diabetes, the metabolic syndrome and hypertension was 8.5%, 45.3% and 29.2%, respectively. Hypertriglyceridemia, hypercholesterolemia and low levels of HDL-c were prevalent in 42.7%, 26.6% and 37% of the subjects, respectively. The prevalence of hypertriglyceridemia was significantly higher in males (p = 0.007); however, low levels of HDL-c were more prevalent in females as compared to males (p = 0.00). CONCLUSION: High prevalence of generalized obesity, abdominal obesity (by measurement of WC, TAF, IAAT and SCAT) and dysmetabolic state in urban Asian Indians in north India need immediate public health intervention

Unusual associations of pachydermoperiostosis: A case report

Primary hypertrophic osteoarthropathy (HOA), or pachydermoperiostosis, is a rare benign disorder of unknown etiology. It is characterized by clubbing, periosteal reaction, and thickening of the skin. Disease usually progresses slowly, and natural arrest may occur. Reported herein is the case of a 28-year-old male patient with progressively increasing swelling of large joints of lower limbs with severe anemia. He was diagnosed as a case of pachydermoperiostosis with myelofibrosis, which is a rare association. The development of myelofibrosis makes primary HOA a disease with unfavorable outcome

Metabolic alterations and systemic inflammation in overweight/obese children with obstructive sleep apnea.

Aim and objectiveSystemic inflammation has been documented in obstructive sleep apnea (OSA). However studies on childhood OSA and systemic inflammation are limited. This study aimed to determine the relation between OSA in overweight/obese children and various inflammatory markers.Material and methodsIn this cross sectional study, we enrolled 247 overweight/ obese children from pediatric outpatient services. We evaluated demographic and clinical details, anthropometric parameters, body composition and estimation of inflammatory cytokines such as interleukin (IL) 6, IL-8, IL-10, IL-17, IL-18, IL-23, macrophage migration inhibitory factor (MIF), high sensitive C-reactive protein (Hs-CRP), tumor necrosis factor-alpha (TNF-α), plasminogen activator inhibitor-1 (PAI-1) and leptin levels. Overnight polysomnography was performed.FindingsA total of 247 children (190 with OSA and 57 without OSA) were enrolled. OSA was documented on polysomnography in 40% of patients. We observed significantly high values body mass index, waist circumference (WC), % body fat, fasting blood glucose (FBG), alanine transaminase (ALT), alkaline phosphate, fasting insulin and HOMA-IR in children with OSA. Inflammatory markers IL-6, IL-8, IL-17, IL-18, MIF, Hs CRP, TNF- α, PAI-1, and leptin levels were significantly higher in OSA patients (pConclusionChildren with OSA have increased obesity, insulin resistance and systemic inflammation. Further studies are require to confirm our findings and evaluate their utility in diagnosis of OSAs, assessing severity and possible interventions

A 71-year-old man with unilateral wheezing: an unusual cause.

We present an unusual case of a 71-year-old man with unilateral wheezing brought on by change in position. Isolated bronchomalacia in the absence of tracheal involvement occurs more commonly in children and in adults with emphysema, chronic bronchitis, extrinsic compression by tumors, compression by abnormal blood vessels or vascular rings, relapsing polychondritis, endotracheal intubation and mechanical ventilation, enlarged left atrium, trauma, and lung transplantation. Our patient had predominant unilateral bronchomalacia. In this report, we present the clinical features, review the literature, and describe the probable pathophysiology

Inferior vena cava anomalies-a common cause of DVT and PE commonly not diagnosed.

A 62-year-old white male presented with recurrent pulmonary embolism (PE) despite having an inferior vena cava (IVC) filter. Investigations ruled out upper limb deep vein thrombosis (DVT) and IVC thrombus, the common causes for a PE in the presence of IVC filter. The culprit was double IVC with a persisting left supracardinal vein that allowed an alternate route for the leg DVT to cause PE. IVC anomalies have a propensity to cause lower limb DVT. Although rarely suspected recent studies have revealed that IVC anomalies are not rare if anticipated and evaluated. Chest CT scans in cases of suspected idiopathic PE should extend up to the renal veins as this will identify common IVC anomalies. Therapy to prevent recurrent DVT can be instituted. A good quality venacavagram should always precede any IVC filter placement as this will identify almost all IVC anomalies and appropriate steps can prevent a recurrent PE

Non-pharmacological management of hypertension

Hypertension is a silent killer. Indians are racially predisposed to cardiovascular disease, and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimal confers additional independent risk of vascular disease, even in ranges previously considered normal. While antihypertensive agents have been used for those patients with blood pressure above the traditional cutoff, there has been increasing emphasis on the prevention and treatment of hypertension by non-pharmacological means, termed ′lifestyle modifications.′ A MEDLINE search was done for relevant references with emphasis on original studies, randomized controlled trials and meta-analyses. Lifestyle modifications that effectively lower blood pressure are increased physical activity, weight loss, limited alcohol consumption, reduced sodium intake and the Dietary Approaches to Stop Hypertension diet. Lifestyle modification is recommended as initial therapy in stage 1 hypertension before initiation of drug therapy and as an adjunct to medication in persons already on drug therapy. In pre-hypertensives, it can reduce the incidence of hypertension and lower end-organ damage. It is emphasized that simple advice from physicians can have a positive influence on patients′ motivation to make lifestyle changes

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Not AvailableAmong fungal diseases, stem root rot or charcoal rot caused by Macrophomina phaseolina (Tassi) Goid is widely distributed and highly destructive disease of sesame. Different synthetic media were tested to select suitable media for the growth of M. phaseolina. Among them, oat meal agar, malt dextrose, Elad and Chet medium showed significantly high mycelial growth at 120 hrs. The maximum growth of M. phaseolina was observed at 30, 35 and 40°C which indicates preference towards higher temperatures and also maximum growth recorded at 5 and 7 pH. Extracts of safflower, mustard, sunflower, groundnut, soybean and sesame amended in media have shown more mycelial growth of M. phaseolina while castor stem extract recorded lowest growth.Not Availabl