Alterations in metabolic status of healthy individuals with and without obesity during transition from adolescence to young adulthood

Aim: Extensive research is carried out throughout the world in healthy persons with obesity phenotype in concern with prevalence, metabolic profiling, etc. To the best of the authors’ knowledge, not many studies have investigated the status of adiponectin, specific inflammatory changes, oxidative damage in healthy adolescents and young adults with obesity. Present study was undertaken in adolescents and young adults of urban population in a district of North Karnataka, India, in a view to understand relationship between hormone adiponectin, oxidative stress markers like C3, C4, high sensitivity C-reactive protein (hs-CRP) in non-hypertensive, non-diabetic, euthyroid individuals with and without obesity. Methods: Participant selection was done using cluster sampling technique. Participating adolescents and young adults, each with and without obesity were included in the study. Screening of participants for diabetes, hypertension, and thyroid disorders was done, their serum level of adiponectin, hs-CRP, C3, C4, ceruloplasmin (Cp), thiobarbituric acid reactive substances (TBARS), and total antioxidant capacity (TAC) were estimated using standardized methods in National Accreditation Board for Testing and Calibration Laboratories (NABL) laboratory. Results: Adiponectin (young adults lower than adolescents, P = 0.01) levels were low, while hs-CRP and Cp (young adults higher than adolescents, P = 0.01) levels were high with increasing age in non-obese. While in persons having obesity, aging adiponectin levels were low while hs-CRP, C3, Cp levels were high significantly. Females without obesity had significantly higher values of C3 than males. Adiponectin showed higher levels in females than males, however, statistical significance could not be achieved (P = 0.308). While females with obesity, exhibited statistically lower levels of adiponectin, and higher levels of C3 and C4. Conclusions: Being non-diabetic and non-hypertensive yet obese, tagged by one time of assay, does not suffice to be categorized as healthy. Healthy young adults with obesity are exhibiting lower levels of adiponectin and higher levels of inflammatory and oxidative stress markers compared to adolescents with obesity. This implies, the so categorized “healthy obese” participants are in a phase of transition towards an unhealthy state.

Association of Lipoprotein (a) in Coronary Artery Disease in Young Individuals

Coronary artery disease (CAD) is one of the commonest heart diseases, accounting for 5-8% global prevalence. Recent studies show a prevalence of 1.2% of CAD cases in young age group. When ethnicity is considered south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%. Predictable risk factors such as smoking, diabetes, hypertension, obesity and family history seems to be as important as in older CAD subjects. But the prevalence of these risk factors seems to vary in younger subjects. Smoking is by far the most commonly associated risk factor in young CAD. Angiographic studies shows predominance of single vessel disease in young CAD patients. Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events. This global data warrants the need for new screening tools and treatment interventions to reduce the incidence/ prevalence of atherothrombotic disease.

MATERIAL

A hospital-based cross-sectional study was conducted on patients between the age group of 18-49 years, admitted in the ICCU fulfilling the inclusion criteria. All the patients who had undergone coronary angiography and satisfying the inclusion criteria were recruited. A total of 104 patients were enrolled. Investigations like complete hemogram, fasting lipid profile (FLP), ECG, ECHO and angiography reports were carried out and results of coronary angiography were noted. Correlations of SVD, DVD, TVD, lipoprotein(a) levels, lipid profiles- total cholesterol, TGL, HDL, LDL were carried out.

OBSERVATION

1) Majority of study population 70 (67.31%) had higher level of Lp(a) and 34 (32.69%) had normal Lp(a) level. 2) LDL was comparatively normal or low in patients with High Lp(a) showing the significance of Lp(a) over LDL analysis for CAD. 3) Subjects with high Lp(a) had SVD with LAD predominant and Diabetics had higher Lp(a) values. 4) A comparison of Lp(a) with subject's presentation in the form of STEMI, NSTEMI and Unstable Angina was studied and it was observed that 43 subjects had STEMI, 41 has NSTEMI and 20 had presented with Unstable Angina. 5) LDL was comparatively normal or low in patients with High Lp(a) showing the significance of Lp(a) over LDL analysis for CAD.

CONCLUSION

The present study suggests the need for routine estimation of Lp(a) in the diagnosis of CAD, which helps in early detection of myocardial damage and timely intervention leading to lowered morbidity and mortality.

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry

Background

The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry.

Methods and results

A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012–2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3–2.3) versus 2.3 (IQR 1.8–2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32–9.35) vs 4.34 (4.16–4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up.

Conclusion

Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF.

Clinical trial registration—URL

http://www.clinicaltrials.gov. Unique identifier: NCT01090362.

Association of Mean Platelet Volume with Acute Ischemic Cerebrovascular Accident Among Patients with Type 2 Diabetes Mellitus: A Hospital-Based Study

OBJECTIVE

To study the association of MPV (mean platelet volume) and acute ischemic stroke in patients of type 2 diabetes mellitus (DM).

MATERIAL

This was a 1-year cross-sectional hospital-based study involving 79 patients presented with acute ischemic stroke. Among them, 25 were diabetic and 54 were nondiabetic. Demographic data and history of the patients were recorded. Investigations such as haemoglobin estimation, platelet count, MPV, HbA1c, imaging studies were conducted and evaluated for acute ischemic brain stroke. All the patients underwent neurological examination according to National Institute of Health Stroke Scale (NIHSS) at the time of admission and MPV was noted. Outcome of stroke was assessed during discharge by modified Rankin morbidity (MRM) score. SPSS 20 was used to analyse the data.

RESULTS

Among 79 them, 25 patients (31.6%) had history of diabetes which formed the diabetic subset and the remaining 54 (68.35%) were considered in non-diabetic subset. MPV in patients with DM was significantly high (10.16 ± 0.89 fL) compared to nondiabetic patients (8.25 ± 0.91 fL; p<0.001). The mean NIHSS scores were significantly high in patients with diabetes compared to nondiabetic patients (20.38±3.19 vs. 17.76±3.74; p=0.006). Also, the mean MRM scores were significantly high in diabetics than that of nondiabetics (4.12 ± 0.66 vs. 3.00 ± 0.61; p<0.001). History of stroke was present in 12% of patients with DM compared to 1.85% of the non-diabetic patients (p=0.091).

CONCLUSION

Acute ischemic stroke in diabetic patients is significantly associated with raised MPV level, which is likely to be severe with high morbidity and mortality. Hence, MPV is an easily available blood parameter, which defines platelet reactivity and proves to be a good predictor of severity and outcome of stroke in diabetics. Also, higher percentile of patients showed history of recurrent stroke in diabetics as compared to non-diabetics in whom the MPV was considerably raised compared to other diabetic stroke cases.

Correlation of Thyroid Hormone Profile with the Acute Physiology and Chronic Health Evaluation II Score as a Prognostic Marker in Patients with Sepsis in the Intensive Care Unit

OBJECTIVES

Thyroid hormones regulate metabolism and homeostasis, and variations in thyroid hormone levels are common in chronically ill patients. Thyroid dysfunction, especially in critically ill patients admitted to the intensive care unit (ICU), is associated with adverse outcomes. This study was conducted to find a correlation between thyroid profile and sepsis and associate it with the acute physiology and chronic health evaluation II (APACHE II) score.

BACKGROUND

:A cross-sectional study was conducted from January 2015 to December 2015 at the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi. A total of 100 patients aged 18 years or more fulfilling the sepsis criteria were included in the study. Patients were subjected to clinical examination followed by systemic examination. The clinical severity as well as the prediction of outcome was assessed by APACHE II score. Based on the outcome, the patients were divided into two groups, namely survivors and nonsurvivors. The data obtained were coded and entered into Microsoft excel spreadsheet and analyzed using SPSS 21. Continuous data were compared using independent sample t-test. The correlation of free triiodothyroxine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) with APACHE II score was done using Pearson's correlation coefficient. At 95% confidence interval, p < 0.05 was considered as statistically significant.

BACKGROUND

Out of 100 patients, 57 patients were men and 43 were women. The mean age of patients was 48.55 ± 18.09 years. Type 2 diabetes mellitus was the most common29 comorbid condition. Pneumonia was the primary diagnosis noted in 31patients followed by pyelonephritis.20 Most18 of the patients had APACHE II scores between 15 and 19. The mean APACHE II score was higher in nonsurvivors as compared to survivors (30.5 ± 7.24 vs. 16.92 ± 8.11; p < 0.001). In the study, 68 patients survived, while 32 of them died. Among nonsurvivors, APACHE II was inversely correlated with fT3 and fT4 levels, while TSH was positively correlated.

BACKGROUND

In ICU patients with sepsis, thyroid profile in combination with the APACHE II score may prove to be a better indicator of ICU morbidity and mortality more accurately than the APACHE II score alone.

APO B/APO AI Ratio with Coronary Artery Disease with Normal Lipid Profile in the Indian Population

BACKGROUND

Abnormal lipids are an important risk factor for development of Coronary Artery Disease, significant patients have normal lipid profile and yet develop CAD. Apolipoproteins B, Apolipoproteins A and their ratio have been shown to be better predictor of risk of developing Coronary artery disease.

OBJECTIVE

Assess the Apo B / Apo A ratio with coronary artery disease in patients with normal lipid profile.

METHODS AND RESULTS

In 4232 patients with history of CAD 3724(88 %) had abnormal apo b / apo a ratio. Of 2920 patients with normal LDL levels (<100 mg), 2454 patients had abnormal apob/apoa ratio of which 2200 (91%) had CAD. In 1946 patients on lipid lowering agents 1819 had abnormal apo b/ apo a ratio and all had CAD.

CONCLUSION

This study ascertains the importance Apo B, Apo A ratio over conventional lipid profile values for predicting CAD and its severity. Apo B/ Apo A ratio and CAD was found to be significant in patients with normal LDL, even in patients with history of dyslipidemia on statins this ratio was significant. Statins have been effective in lowering LDL, but have not shown changes in Apo B levels. Apo B and Apo A should be used to assess the atherogenic potential of lipid disorders.

Significance of myocardial ischaemia before cardiac catheterisation in patients with ischemic heart disease

Eighty one patients with ischemic heart disease divided in four groups (group 1, n = 24, without ischemia; group II, n = 20, myocardial ischemia before invasive procedure; group III, n = 18, myocardial ischemia during invasive procedure, group IV, n = 19, myocardial ischemia before and during the invasive procedure) were studied at rest, by bicycle ergometric exercise test and cardiac catheterisation (including selective coronary angiography) to assess the response of autonomic nervous system as judged by the non-invasive parameters of myocardial oxygen demand. Patients in group II and IV had increased double product before the invasive procedure, diminished coronary reserve and left ventricular ejection performance although the vessel involvement in these groups was similar to that of other two groups. Patients with ischemic heart disease manifest different degree of myocardial ischemia before and during cardiac catheterisation depending upon the activity of autonomic nervous system.

Significance of left ventricular shape, its blood supply and calcium turnover for evolving myocardial hypertrophy

To explore relationship between hypertrophy of left ventricle and its shape, blood supply and calcium turnover, the study enrolled 105 male patients with ischemic heart disease or those suspected of its presence. All patients underwent contrast coronary ventriculography, M-mode echocardiography and sectorial scanning. Moderately limited myocardial blood supply was found to be a factor, stimulating its local hypertrophy. In the event of severely impaired blood supply, no substantial myocardial hypertrophy is detectable in corresponding regions, while dynamic observation not infrequently reveals thinning of the wall. Patients with intact coronary arteries, and having more elongated shape of left ventricular cavity, demonstrate larger thickness of walls along the long axis, that is probably due to dependence of intramyocardial tension on the radius of the wall curvature. While performing ventriculography in the patients with hypertrophic myocardium, disclosed elevated level of calcium in the blood and enhanced calcium uptake by cardiac muscle versus patients without left ventricular hypertrophy.