Cardiac autonomic dysfunctions in type 2 diabetes mellitus: an investigative study with heart rate variability measures

Cardiac autonomic neuropathy (CAN) is a common yet underdiagnosed complication of Type 2 diabetes mellitus (T2DM). Heart rate variability (HRV), a sensitive diagnostic marker of cardiovascular risk, could help detect CAN at its earliest stage. However, the progression of CAN based on age and disease duration in T2DM is lacking. In this study, we propose to explore the occurrence of CAN in patients with varying stages and duration of T2DM. This cross-sectional study involves participants with T2DM (n = 160) and healthy volunteers (n = 40) with an age range of 30-60 years of both genders. Patients in the T2DM group were further subdivided into four subgroups based on their disease duration [Prediabetes, disease duration <5 yrs (D1), 5-10 yrs (D2), and >10 yrs (D3)]. All participants underwent short-term HRV recording for 20 minutes and analyzed for both time and frequency domain measures. The study results showed a significant increase in Heart Rate (HR) in D1 (P = 0.031) and D3 (P = 0.001) groups compared to healthy controls. The time-domain measures of HRV were significantly reduced in the T2DM group compared to the healthy controls. Furthermore, this reduction is more intense in the D3 group than in D2 and D1. Correspondingly, in frequency domain parameters: total power, high-frequency power, and low-frequency power were significantly reduced in all the T2DM groups compared to healthy controls. The study concludes that the overall HRV (as determined by total power), sympathetic activity (low frequency power) and parasympathetic activity (time domain measures and high frequency power) were significantly reduced in all the diabetic subgroups except prediabetes as compared to the healthy controls, implying that both sympathetic and parasympathetic limbs are symmetrically affected in T2DM patients even in the earliest stages (<5 yrs) implying subclinical cardiac autonomic dysfunction in the earliest stages.

Genetic structure of a small closed population of the New Zealand white rabbit through pedigree analyses

The genetic structure of a small population of New Zealand White rabbits maintained at the Sheep Breeding and Research Station, Sandynallah, The Nilgiris, India, was evaluated through pedigree analyses. Data on pedigree information (n=2503) for 18 yr (1995-2012) were used for the study. Pedigree analysis and the estimates of population genetic parameters based on the gene origin probabilities were performed. The analysis revealed that the mean values of generation interval, coefficients of inbreeding and equivalent inbreeding were 1.49 yr, 13.23 and 17.59%, respectively. The proportion of population inbred was 100%. The estimated mean values of average relatedness and individual increase in inbreeding were 22.73 and 3.00%, respectively. The percentage increase in inbreeding over generations was 1.94, 3.06 and 3.98 estimated through maximum generations, equivalent generations and complete generations, respectively. The number of ancestors contributing the majority of 50% genes (f_a50) to the gene pool of reference population was only 4, which might have led to reduction in genetic variability and increased the amount of inbreeding. The extent of genetic bottleneck assessed by calculating the effective number of founders (f_e) and the effective number of ancestors (f_a), as expressed by the f_e/f_a ratio was 1.1, which is indicative of the absence of stringent bottlenecks. Up to 5th generation, 71.29% pedigree was complete, reflecting the well maintained pedigree records. The maximum known generations were 15, with an average of 7.9, and the average equivalent generations traced were 5.6, indicating a fairly good depth in pedigree. The realized effective population size was 14.93, which is very critical, and with the increasing trend of inbreeding the situation has been assessed as likely to become worse in future. The proportion of animals with the genetic conservation index (GCI) greater than 9 was 39.10%, which can be used as a scale to use such animals with higher GCI to maintain balanced contribution from the founders. From the study, it was evident that the herd was completely inbred, with a very high inbreeding coefficient, and the effective population size was critical. Recommendations were made to reduce the probability of deleterious effects of inbreeding and to improve genetic variability in the herd. The present study can help in carrying out similar studies to meet the demand for animal protein in developing countries.

Estimates of (co)variance components and genetic parameters for body weights and growth efficiency traits in the New Zealand white rabbit

The genetic parameters of growth traits in the New Zealand White rabbits kept at Sheep Breeding and Research Station, Sandynallah, The Nilgiris, India were estimated by partitioning the variance and covariance components. The (co)variance components of body weights at weaning (W42), post-weaning (W70) and marketing (W135) age and growth efficiency traits viz., average daily gain (ADG), relative growth rate (RGR) and Kleiber ratio (KR) estimated on a daily basis at different age intervals (42 to 70 d; 70 to 135 d and 42 to 135 d) from weaning to marketing were estimated by restricted maximum likelihood, fitting 6 animal models with various combinations of direct and maternal effects. Data were collected over a period of 15 yr (1998 to 2012). A log-likelihood ratio test was used to select the most appropriate univariate model for each trait, which was subsequently used in bivariate analysis. Heritability estimates for W42, W70 and W135 were 0.42±0.07, 0.40±0.08 and 0.27±0.07, respectively. Heritability estimates of growth efficiency traits were moderate to high (0.18 to 0.42). Of the total phenotypic variation, maternal genetic effect contributed 14 to 32% for early body weight traits (W42 and W70) and ADG1. The contribution of maternal permanent environmental effect varied from 6 to 18% for W42 and for all the growth efficiency traits except for KR2. Maternal permanent environmental effect on most of the growth efficiency traits was a carryover effect of maternal care during weaning. Direct maternal genetic correlations, for the traits in which maternal genetic effect was significant, were moderate to high in magnitude and negative in direction. Maternal effect declined as the age of the animal increased. The estimates of total heritability and maternal across year repeatability for growth traits were moderate and an optimum rate of genetic progress seems possible in the herd by mass selection. The genetic and phenotypic correlations among body weights and between growth efficiency traits were also estimated. Moderate to high heritability and higher genetic correlation in body weight traits promise good scope for genetic improvement provided measures are taken to keep the inbreeding at the lowest level.

Comparison of temperature rise in the pulp chamber with different light curing units: An in-vitro study

Aims/Objectives:

This in vitro study was designed to measure and compare the temperature rise in the pulp chamber with different light curing units.

Materials and Methods:

The study was done in two settings-in-vitro and in-vivo simulation. In in-vitro setting, 3mm and 6mm acrylic spacers with 4mm tip diameter thermocouple was used and six groups were formed according to the light curing source- 3 Quartz-Tungsten-Halogen (QTH) units and 3 Light-Emitting-Diode (LED) units. For the LED units, three modes of curing like pulse-cure mode, fast mode and ramp mode were used. For in-vivo simulation, 12 caries free human third molar tooth with fused root were used. K-type thermocouple with 1 mm tip diameter was used. Occlusal cavity was prepared, etched, rinsed with water and blot dried; bonding agent was applied and incremental curing of composite was done. Thermal emission for each light curing agent was noted.

Results:

Temperature rise was very minimal in LED light cure units than in QTH light cure units in both the settings. Temperature rise was minimal at 6mm distance when compared to 3 mm distance. Among the various modes, fast mode produces the less temperature rise. Temperature rise in all the light curing units was well within the normal range of pulpal physiology.

Conclusion:

Temperature rise caused due to light curing units does not result in irreversible pulpal damage.

Effect of deep breathing at six breaths per minute on the frequency of premature ventricular complexes

Although the effect of reflex increase in vagal tone on the frequency of premature ventricular complexes (PVC) is known, the effect of timed deep breathing on the frequency of PVC has not been reported. We serendipitously discovered that deep breathing at six breaths per minute abolished PVC in an 18-year-old female with frequent PVC, anxiety, and palpitations. In five of a series of 10 consecutive patients with frequent (> or = 10/min) unifocal PVC, deep breathing at 6 breaths/min reduced the frequency of PVC by at least 50%. This is possibly due to increased vagal modulation of sinoatrial and atrioventricular node. However, factors predicting the response to deep breathing, and the mechanisms involved need to be studied in a larger number of patients.

Supravalvular aortic stenosis and coronary ostial stenosis in homozygous familial hypercholesterolemia

Patients with homozygous familial hypercholesterolemia exhibit severe hypercholesterolemia, cutaneous and tendon xanthomata, and premature atherosclerosis from childhood. A rare presentation of this condition with supravalvular aortic stenosis and coronary ostial stenosis is described.

Prevalence of left atrial thrombus in rheumatic mitral stenosis with atrial fibrillation and its response to anticoagulation: a transesophageal echocardiographic study

BACKGROUND

The frequency of occurrence of left atrial thrombi, and the effect of anticoagulation in patients with rheumatic mitral stenosis and atrial fibrillation is not well established. This study was conducted to evaluate the occurrence of left atrial body and left atrial appendage clots in patients with rheumatic mitral stenosis and atrial fibrillation, and to document the effect of long-term anticoagulation on clot dissolution.

METHODS AND RESULTS

Consecutive patients with severe rheumatic mitral stenosis and atrial fibrillation were assessed by transesophageal echocardiography. Those with left atrial body or left atrial appendage clots were anticoagulated with oral nicoumalone. Transesophageal echocardiography was then repeated in patients on anticoagulation who were on regular follow-up, and in whom percutaneous transvenous mitral commissurotomy could be considered. Of the 490 patients studied, 163 had left atrial body or left atrial appendage clots. A repeat transesophageal echocardiographic examination was done in 50 patients who had optimal anticoagulation for a period of 6 months. Only 2 of the 17 patients who had left atrial body clots had successful clot dissolution after long-term anticoagulation, while the left atrial appendage clots disappeared in 31 of 33 patients (p<0.001).

CONCLUSIONS

Left atrial clots are present in a third of patients with severe rheumatic mitral stenosis and atrial fibrillation. Isolated left atrial appendage clots in patients with rheumatic mitral stenosis and atrial fibrillation can disappear with long-term anticoagulation, while thrombi that extend into the left atrial body may persist despite optimal anticoagulation.

Radiofrequency ablation for post infarction ventricular tachycardia. Report of a single centre experience of 112 cases

OBJECTIVES

This report presents the largest consecutive series to date of radiofrequency ablation in the treatment of post infarction ventricular tachycardia.

METHODS

One hundred and twelve consecutive patients were studied, with an average of 12 documented episodes of ventricular tachycardia in the month preceding the radiofrequency ablation. Seventy-four percent of the subjects had an ejection fraction of less than 35%; 84% had more than one morphology of ventricular tachycardia and 30% had haemodynamically unstable ventricular tachycardia. The mean follow-up period was 61 months.

RESULTS

Complete success defined as no inducible sustained monomorphic ventricular tachycardia was achieved in 38%. Modified result, defined as ventricular tachycardia only inducible by two stimuli more aggressive than at baseline was achieved in 34%. During follow-up, ventricular tachycardia recurred in 25 patients: 22 after a failed procedure, two following a modified result and one following a complete success. Twenty-five patients died: 13 of progressive cardiac failure and four of presumed arrhythmic causes, three after a failed procedure and one following a modified result. There were no procedure-related deaths. Procedural complications occurred in seven patients.

CONCLUSIONS

In this report, radiofrequency ablation of post infarction ventricular tachycardia is a successful procedure with a low complication rate. Acute procedural success accurately predicts long-term freedom from recurrent ventricular tachycardia.

Correlation between the spermatozoal characteristics and sperm penetration distance in polyacrylamide gel and bovine cervical mucus

Correlation between the spermatozoal characteristics and the sperm penetration distance in polyacrylamide gel was assessed, utilizing frozen thawed semen samples obtained from 6 bulls, and it was compared with the correlation between sperm penetration in bovine cervical mucus and spermatozoal characteristics. In vitro sperm penetration tests were performed with mucus and gel. The sperm penetration in gel and mucus was significantly and positively correlated with post-thaw motility (r=0.81; r=0.89:P<0.01) and acrosome integrity (r=0.88; r=0.94:P<0.01). A significant negative correlation with abnormal spermatozoa (r=-0.84;r=0.83:P<0.01) was observed. Both sperm concentration and post-thaw live spermatozoa were not significantly correlated. A significant multiple regression between sperm penetration and the spermatozoal characteristics both in gel (R2=0.87; F=40.27; P<0.01) and mucus (R2=0.91; F=60.48; P<0.01) was observed. The major spermatozoal characteristics determining the capacity of spermatozoa to penetrate gel were post-thaw motility, percentage of abnormal spermatozoa and acrosome integrity. The acrosome integrity has a more significant contribution. The correlation established with sperm penetration in gel was very similar to that of sperm penetration in mucus. The utility of gel as a mucus substitute in in vitro sperm penetration tests was discussed.