Carotid intima-media thickness in patients with non-alcoholic fatty liver disease: a study from eastern part of India

Background: Carotid intima-media thickness (CIMT) is a reliable marker of atherosclerosis and cardiovascular events. Association between CIMT with non-alcoholic fatty liver disease (NAFLD) is well known; however, such data are limited from India. This study aimed to assess CIMT in NAFLD patients compared to the healthy control, its relationship with other metabolic covariates, and predators of increased CIMT. Methods: In an observational study, involving 150 subjects (84 NAFLD and 66 healthy controls), B-mode ultrasound was used for the evaluation of CIMT. Results: The mean CIMT was significantly higher in NAFLD patients compared to the control group: 0.77±0.27 versus 0.57±0.11 mm on left side, p<0.001 and 0.79±0.22 versus 0.54±0.12 mm on right side, p<0.001. The difference was significant even after adjustment of metabolic confounders. Eight NAFLD patients had carotid plaques compared to none in the controls. The mean CIMT did not differ significantly between lean, overweight and obese subjects. A progressive increase in mean CIMT was noted with increasing grades of hepatic steatosis. High CIMT values (>95th percentile value in controls, 0.79 mm) were found in 52.3% of NAFLD. On multivariate regression analysis, age [odds ratio (OR) 1.42, p<0.001], serum HDL cholesterol [OR 0.92), p=0.02] and NAFLD [OR: 3.5, p<0.001] were found to be independently associated with high CIMT. Conclusions: NAFLD was significantly associated with CIMT which increased progressively with increasing grades of hepatic steatosis. Over half of NAFLD had increased CIMT, and NAFLD along with higher age and lower HDL- cholesterol independently predicted high CIMT values

Coronary artery disease prevalence amongst patients undergoing valve replacement surgery: A South African perspective

Background: The prevalence of coronary artery disease (CAD) amongst patients presented for valve surgery has important implications for routine angiography. Information on the frequency of CAD in predominantly black patients presented for valve surgery in South Africa has not been published.Methods: A retrospective, descriptive study of 116 patients presented for valve surgery that underwent coronary angiography between 2010 and 2011 was performed. CAD was defined as stenosis of 70% or greater in one or more epicardial vessels or ≥50% in the left main coronary artery, as defined by quantitative coronary angiography.Results: Median age was 57.4 (IQR 43 - 67) years (56.9% females). Black patients represented 66.4%, whites 19.8%, and, coloured and Indian patients 13.8%. Hypertension and smoking were the most common cardiovascular risk factors (26.7% and 16.4% respectively). Diabetes mellitus, dyslipidaemia, chronic kidney disease and prior CAD occurred collectively in 15.5% of study subjects. HIV prevalence was 12%, half of whom were on antiretroviral therapy. An isolated valve lesion occurred in 69% of patients, with the remainder having 2 or more lesions. The most common valve lesion was aortic stenosis (43.1%), followed by mitral stenosis (36.2%), aortic regurgitation (29.3%), mitral regurgitation (25.9%) and tricuspid regurgitation (19%). The predominant aetiology was rheumatic heart disease (58.6%), followed by degenerative valve disease (24.1%). CAD was documented in 10 patients (8.6%), of whom 8 had single vessel disease and 2 had double vessel disease.Conclusion: The low prevalence of CAD found in younger, asymptomatic black patients without cardiovascular risk factors referred for valve surgery, raises the question of whether routine pre-operative coronary angiography in this sub-group is appropriate

Isolated orbital myocysticercosis in a Muslim boy

Orbital cysticercosis is secondary to an infestation by Cysticercus cellulosae, the larval form of Taenia solium. We report a case of isolated orbital myocysticersosis in a four year old non pork eater boy who presented with sign and symptoms suggestive of mass lesion in superior orbit. He was managed with medical line of treatment and showed complete resolution of his symptoms. It becomes important to report this case because of unusual site of the cyst, young age of the patient and to highlight the importance of proper sanitary measures in preventing this disease

Ethnicity and detention : are black and minority ethnic (BME) groups disproportionately detained under the Mental Health Act 2007?

Purpose There is substantial evidence to suggest that Black and minority ethnic (BME) patients are disproportionately detained under the Mental Health Act (MHA). We examined ethnic differences in patients assessed for detention and explored the effect of ethnicity after controlling for confounders. Methods A prospective study of all MHA assessments conducted in 1 year (April 2009–March 2010) within Birmingham and Solihull Mental Health Foundation Trust, UK. Proportion of assessments and detentions within denominator population of service users and regional populations were calculated. Multiple regression analysis was conducted to determine which variables were associated with the outcome of MHA assessment and the role of ethnicity. Results Of the 1115 assessments, 709 led to detentions (63.58 %). BME ethnic groups were statistically more likely to be assessed and detained under the MHA as compared to Whites, both in the service user and the ethnic population estimates in Birmingham, UK. MHA detention was predicted by having a serious mental illness, the presence of risk, older age and living alone. Ethnicity was not associated with detention under the MHA with age, diagnosis, risk and level of social support accounted for. Conclusion The BME ‘disproportionality’ in detention rates seems to be due to higher rates of mental illness, greater risk and poorer levels of social support rather than ethnicity per se

Oxidation of the Platinum (II) Anticancer Agent [Pt{(p-BrC6F4)NCH2CH2NEt2}Cl(py)] to Platinum (IV) Complexes by Hydrogen Peroxide

PtIV coordination complexes are of interest as prodrugs of PtII anticancer agents, as they can avoid deactivation pathways owing to their inert nature. Here, we report the oxidation of the antitumor agent [PtII(p-BrC6F4)NCH2CH2NEt2}Cl(py)], 1 (py = pyridine) to dihydroxidoplatinum(IV) solvate complexes [PtIV{(p-BrC6F4)NCH2CH2NEt2}Cl(OH)2(py)].H2O, 2·H2O with hydrogen peroxide (H2O2) at room temperature. To optimize the yield, 1 was oxidized in the presence of added lithium chloride with H2O2 in a 1:2 ratio of Pt: H2O2, in CH2Cl2 producing complex 2·H2O in higher yields in both gold and red forms. Despite the color difference, red and yellow 2·H2O have the same structure as determined by single-crystal and X-ray powder diffraction, namely, an octahedral ligand array with a chelating organoamide, pyridine and chloride ligands in the equatorial plane, and axial hydroxido ligands. When tetrabutylammonium chloride was used as a chloride source, in CH2Cl2, another solvate, [PtIV{(p-BrC6F4)NCH2CH2NEt2}Cl(OH)2(py)].0.5CH2Cl2, 3·0.5CH2Cl2, was obtained. These PtIV compounds show reductive dehydration into PtII [Pt{(p-BrC6F4)NCH=CHNEt2}Cl(py)], 1H over time in the solid state, as determined by X-ray powder diffraction, and in solution, as determined by 1H and 19F NMR spectroscopy and mass spectrometry. 1H contains an oxidized coordinating ligand and was previously obtained by oxidation of 1 under more vigorous conditions. Experimental data suggest that oxidation of the ligand is favored in the presence of excess H2O2 and elevated temperatures. In contrast, a smaller amount (1Pt:2H2O2) of H2O2 at room temperature favors the oxidation of the metal and yields platinum(IV) complexes

Efficacy and safety of the trans-obturator tape for female stress urinary incontinence

Background: To assess the safety and efficacy of Trans-obturator tape (TVT-O) for female stress urinary incontinence (SUI).Methods: A cohort of 35 cases of SUI and underwent TVT-O procedure over a period of 4 years. Pre-operative evaluation included pelvic examination, one hour pad test, urodynamic study, urinary diary and baseline haematological tests. Post-operatively all women had post-void residual volume and were followed up for 3 years.Results: The mean age of the patients was 47±9.5 years. TVT-O alone was done in 58.1% of cases. 41.9% of cases had TVT-O done as a concomitant procedure. The median duration of follow-up was 48 months. The overall objective and subjective cure rate was 92.3% with failure rate of 7.7%, 12.9% of women reported post-operative thigh pain and 6.5% patients had immediate post-operative urinary retention. 16.1% of the patients had post-operative voiding dysfunction. No major complications were encountered in these patients.Conclusions: TVT-O is a safe, easy and effective minimally invasive procedure for female SUI with minimal acceptable complications

Ocular involvement in diabetic patients attending tertiary care centres of eastern U.P., India: a prospective study

Background: Diabetes mellitus is increasing day by day in developing countries especially in India. It is a main treatable cause of morbidity in eye. Diabetic cataract, neovascular glaucoma and retinopathy are important ocular complications due to diabetes mellitus. The objective was to study the variations in ocular complications in patients of diabetes mellitus.Methods: A prospective study from July 2012 to June 2013 was conducted in RMCH and RC, Kanpur & GSVM Medical College, Kanpur. One hundred one selected diabetic patients who are having abnormal slit lamp and fundus examination were included in this study.Results: In our study it was found that more the duration of diabetes, greater the severity of diabetes. Well controlled diabetics have lesser complications in eyes due to diabetes.Conclusion: Patient’s age, sex, duration and control of diabetes play important role in development and severity of complications in eye due to diabetes mellitus