Publications by authors named "Naval Kishore Vikram"

21 Publications

  • Page 1 of 1

Differential expression of insulin receptor substrate-1(IRS-1) in visceral and subcutaneous adipose depots of morbidly obese subjects undergoing bariatric surgery in a tertiary care center in north India; SNP analysis and correlation with metabolic profile.

Diabetes Metab Syndr 2021 May-Jun;15(3):981-986. Epub 2021 May 5.

Department of Biochemistry, All India Institute of Medical Sciences, Delhi, India. Electronic address:

Background: /aim: Abdominal obesity and associated metabolic consequences are a burgeoning problem in Asian Indians and studying their genetic predisposition is important. This study is aimed at assessing variations in Insulin receptor substrate-1 (IRS-1), its expression at regional fat-depots (visceral and subcutaneous) in morbidly obese patients, and correlation with genotype-phenotype traits.

Methods: Gene expression of IRS-1 in paired adipose tissue from 35 morbidly obese subjects (BMI) > 40 kg/m) with co-morbidities and 15 controls (BMI<25 kg/m), undergoing bariatric/elective abdominal surgery, respectively was determined by quantitative real time PCR. Genotyping of IRS-1Gly972Arg (n = 436) (rs 1801278) was performed by PCR-RFLP. Metabolic parameters were assessed. Full length sequencing of IRS-1 was performed to identify known/novel variations.

Results: A marked reduction in IRS-1 expression was observed in visceral as compared to subcutaneous adipose tissue of morbidly obese subjects (p = 0.02). Homozygous variant of IRS-1 Gly972Arg was absent and there was no association with obesity or insulin resistance. A salient finding of this study was identification of two new variants in IRS-1 gene, representing G > A (codon 1102) encoding Glu > Lys and a deletion of (A) at codon 658 in morbidly obese subjects with insulin resistance.

Conclusions: Observation of a substantially lower expression of IRS-1 for first time in visceral adipose tissue of morbidly obese subjects is suggestive of predictive role of IRS-1 expression in insulin responsiveness of visceral adipose tissue. New variants in IRS-1, a non-synonymous mutation and a deletion should be evaluated further for their role in development of obesity and/orT2DM.
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http://dx.doi.org/10.1016/j.dsx.2021.04.014DOI Listing
May 2021

Rampant spread of infection in an afebrile immune-competent patient presenting with young-onset ischaemic stroke.

BMJ Case Rep 2020 Aug 25;13(8). Epub 2020 Aug 25.

Medicine, All India Institute of Medical Sciences, New Delhi, India.

A 27-year-old healthy woman developed spontaneous right-sided orbital cellulitis, followed by left hemiparesis and cranial nerve palsies. MRI revealed underlying basal exudates and vasculitic infarction involving the pons and cerebellar peduncles, following which a cerebrospinal fluid examination confirmed acute bacterial meningitis. Although the patient remained afebrile, imaging revealed asymptomatic septic foci in bilateral lungs, empyema and pyelonephritis. Blood culture grew drug-resistant The case highlights the absence of fever in an immune-competent patient presenting with young-onset stroke secondary to meningitis.
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http://dx.doi.org/10.1136/bcr-2020-235495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449355PMC
August 2020

Case of mucormycosis of mandible after self-extraction of teeth incidentally detected to have chronic granulomatous disease: Case report and literature review.

Med Mycol Case Rep 2020 Jun 11;28:55-59. Epub 2020 Apr 11.

Department of Medicine, All India Institute of Medical Science, New Delhi, 110029, India.

Mucormycosis isolated to the mandible is a rare presentation occurring generally after dental procedures. The case we report presented with discharging sinuses over facial region with radiological appearance of isolated osteomyelitis of the mandible. The patient used to apply an addictive dental powder over his teeth leading to caries. Following this, he pulled out all his teeth, which probably led to his condition. Invasive sampling revealed mucormycosis. An extensive search for an underlying immunodeficiency revealed that the patient had chronic granulomatous disease (CGD). Despite a prolonged course of L-Amphotericin B, the patient continued to have intermittent pus discharge and surgical debridement and curettage was eventually required. The patient had a chronic course with minimal soft tissue involvement which initially did not raise the suspicion of mucormycosis. The main learning point is that an unusual invasive fungal infection in an otherwise healthy host can be the first symptom of an underlying primary immunodeficiency, like CGD. Invasive fungal infections in patients with CGD often have an indolent course.
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http://dx.doi.org/10.1016/j.mmcr.2020.03.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7248539PMC
June 2020

Chylothorax in a Case of Accelerated Silicosis with Pulmonary Silicoproteinosis: A Unique Association.

Indian J Occup Environ Med 2020 Jan-Apr;24(1):39-41. Epub 2020 Mar 18.

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

A 32-year-old gentleman, a worker in a cement-manufacturing facility with suspected silica-induced lung disease presented with acutely worsening Type 1 respiratory failure. With a negative work-up for infectious causes and no further revelations on bronchoalveolar lavage fluid or endobronchial biopsy, it was a transbronchial biopsy that ultimately led us to a diagnosis of silicoproteinosis with accelerated silicosis. Interestingly, the patient had a pleural effusion which on thoracentesis showed chylous fluid-the first reported case of chylothorax in association with silicosis.
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http://dx.doi.org/10.4103/ijoem.IJOEM_63_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227742PMC
March 2020

Colistin-induced acquired Bartter-like syndrome: an unusual cause of meltdown.

BMJ Case Rep 2020 Feb 5;13(2). Epub 2020 Feb 5.

Medicine, All India Institute of Medical Sciences, New Delhi, India.

Colistin-induced nephrotoxicity is commonly associated with elevation of serum creatinine level or a reduction of urine output. Uncommonly, tubulopathy associated with colistin has been reported. Here we present a unique case of a 46-year-old man who developed polyuria, hypokalaemia, hypocalcaemia, hypomagnesemia and metabolic alkalosis after 3 days of therapy with intravenous colistimethate sodium. After ruling out other causes, a diagnosis of colistin-induced acquired Bartter syndrome was made. The patient required daily aggressive intravenous repletion of fluids and electrolytes. However, polyuria and metabolic abnormalities abated only after drug discontinuation.
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http://dx.doi.org/10.1136/bcr-2019-232630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021182PMC
February 2020

Cutaneous microembolism: a close mimic of Janeway's lesion.

BMJ Case Rep 2019 Oct 14;12(10). Epub 2019 Oct 14.

Medicine, All India Institute of Medical Science, New Delhi, India.

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http://dx.doi.org/10.1136/bcr-2019-232129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206920PMC
October 2019

Haemophagocytic lymphohistiocytosis in patients with human immunodeficiency virus infection: to treat or not to treat.

Pan Afr Med J 2019 6;32:105. Epub 2019 Mar 6.

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

Haemophagocytic lymphohistiocytosis (HLH) in Human Immunodeficiency Virus (HIV) infected individuals can either be due to the disease itself or due to associated infections/malignancies. The treatment for HLH requires immunosuppressive therapy but administering immunosuppressive therapy to an already immunosuppressed patient (HIV infection) is complex. We present two such cases of HLH in patients infected with HIV. In the first case, no alternate cause for HLH was found even after extensive investigations and it was attributed to the uncontrolled HIV replication. Patient was started on dexamethasone for the same but succumbed to hospital acquired pneumonia. The second patient was diagnosed with Hodgkin's lymphoma but he succumbed to his illness before initiating immunosuppressive therapy for HLH. We report these cases to highlight the dilemma and a need for further research in this direction.
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http://dx.doi.org/10.11604/pamj.2019.32.105.14764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560963PMC
July 2019

Binge alcohol consumption leading to hypokalemic rhabdomyolysis.

BMJ Case Rep 2019 May 23;12(5). Epub 2019 May 23.

Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India.

A 43-year-old man presented with acute onset rapidly progressive weakness in all four limbs (proximal greater than distal), following an episode of binge alcohol ingestion, and was admitted for evaluation and management. There was a history of decreased urine output since 2 days with dark-coloured urine. He was found to have severe hypokalemia and renal dysfunction. Serum creatine kinase was significantly high, and further investigation revealed significantly elevated serum and urine myoglobin levels suggestive of rhabdomyolysis, which was secondary to severe hypokalemia. Following supplementation with intravenous and oral potassium and supportive care, the weakness improved significantly, and he was subsequently discharged. This case describes severe hypokalemia, resulting in rhabdomyolysis and generalised lower motor neuron weakness, in a setting of binge alcohol ingestion, which is an entity rarely described in literature.
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http://dx.doi.org/10.1136/bcr-2019-229307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536223PMC
May 2019

A case of chronic lead poisoning with herbal-based medication.

BMJ Case Rep 2019 04 1;12(4). Epub 2019 Apr 1.

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1136/bcr-2018-227954DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453263PMC
April 2019

Neuroleptic malignant-like syndrome causing thrombocytopaenia: a rare association.

BMJ Case Rep 2018 Dec 3;11(1). Epub 2018 Dec 3.

Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Neuroleptic malignant-like syndrome is a rare but potentially fatal complication of sudden withdrawal of dopaminergic drugs. Clinical features are similar to that of neuroleptic malignant syndrome (NMS) like hyperthermia, autonomic dysfunction, altered sensorium, muscle rigidity; but instead of history of neuroleptic use, there is history of withdrawal of dopaminergic drugs. Laboratory examination generally show elevated creatine phosphokinase levels and may show elevated total leucocyte count. Thrombocytopaenia has been very rarely reported with NMS but it has not been reported with NM-like syndrome. Here, we discuss a case of Parkinson's disease which presented with typical clinical features and risk factors of NM-like syndrome associated with thrombocytopaenia and type 1 respiratory failure. He was treated with bromocriptine and supportive care. Thrombocytopaenia and respiratory failure resolved with above treatment. The patient improved clinically and was successfully discharged on day 12 of admission.
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http://dx.doi.org/10.1136/bcr-2018-227089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301563PMC
December 2018

Deficiencies of Serum Ferritin and Vitamin B12, but not Folate, are Common in Adolescent Girls Residing in a Slum in Delhi.

Int J Vitam Nutr Res 2015 ;85(1-2):14-22

1 Centre for Promotion of Nutrition Research and Training with Special Focus on North-East, Tribal and Inaccessible Population (Indian Council of Medical Research), New Delhi, India.

Anemia among adolescent girls is one of the major challenges faced by India. The present study was undertaken to assess the prevalence of anemia and status of other hematological parameters among adolescent girls (11 - 18 years) residing in an urban slum of Delhi. A total of 794 adolescent girls were recruited for the study. The prevalence of anemia was estimated using the cyanmethemoglobin method. Serum levels of ferritin, folic acid and vitamin B12 were estimated for anemic subjects. The prevalence of anemia was reported as 58.7 %, with 31.6 %, 25.7 % and 1.4 % of subjects being mild, moderate and severely anemic. Hemoglobin levels of subjects who had attained menarche were found to be significantly lower than those who had not attained menarche. The prevalence of serum ferritin, folic acid and vitamin B12 deficiency among those who were anemic was reported as 41.1 %, 5.0 % and 63.3 % respectively. A total of 23.5 % anemic subjects had concomitant micronutrient deficiencies of serum vitamin B12 and ferritin. The results indicate that supplemental iron and vitamin B12 may better address the burden of anemia in adolescent girls in Delhi.
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http://dx.doi.org/10.1024/0300-9831/a000219DOI Listing
February 2016

Procalcitonin as a prognostic marker for sepsis: a prospective observational study.

BMC Res Notes 2014 Jul 17;7:458. Epub 2014 Jul 17.

Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.

Background: Procalcitonin is useful for the diagnosis of sepsis but its prognostic value regarding mortality is unclear. This prospective observational study was designed to study the prognostic value of procalcitonin in prediction of 28 day mortality in patients of sepsis. Fifty-four consecutive patients of sepsis, severe sepsis and septic shock defined using the 2001 Consensus Conference SCCM/ESICM/ACCP/ATS/SIS criteria from medical Intensive Care Unit (ICU) of a tertiary care center in New Delhi, India were enrolled from July 2011 to June 2013. Procalcitonin (PCT), C-reactive protein (CRP) measurements were recorded on day 1, day 7 and day 28 of follow up.

Results: Procalcitonin value was a better predictor of all-cause short-term mortality than C-reactive protein. Those patients with Procalcitonin levels <7 ng/ml showed higher cumulative survival than those with level [greater than or equal to]7 ng/ml (69.1% vs. 39.5%, p = 0.02). No such effect was observed in relation to C-reactive protein. Procalcitonin levels [greater than or equal to]7 ng/ml predicted mortality with a hazard ratio of 2.6(1.1-6.3).

Conclusions: A Procalcitonin value [greater than or equal to]7 ng/ml obtained at the time of admission to the ICU is a predictor of short-term mortality and thus may allow the identification of those septic patients at increased mortality risk, and help improve their treatment.
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http://dx.doi.org/10.1186/1756-0500-7-458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105100PMC
July 2014

Vitamin D insufficiency is associated with abdominal obesity in urban Asian Indians without diabetes in North India.

Diabetes Technol Ther 2014 Jun 14;16(6):392-7. Epub 2014 Feb 14.

1 Department of Medicine, All India Institute of Medical Sciences , New Delhi, India .

Objective: We evaluated the associations of serum 25-hydroxyvitamin D [25(OH) D] levels with clinical, biochemical, and anthropometric profiles and total abdominal adipose tissue (TAAT), subcutaneous abdominal adipose tissue (SCAT), and intraabdominal adipose tissue (IAAT) depots in Asian Indians without diabetes residing in north India.

Subjects And Methods: In this cross-sectional study (n=137; 74 males and 63 females; 18-60 years of age), anthropometric (body mass index, waist and hip circumferences, and skinfold thickness at four sites) and biochemical (fasting plasma glucose, lipid profile, and fasting insulin levels) assessments were done. Measurement of percentage body fat was done by dual energy x-ray absorptiometry, and areas of TAAT, SCAT and IAAT were measured at the L2-L3 intervertebral level by single-slice magnetic resonance imaging. Levels of 25(OH) D were measured by radioimmunoassay. Correlation analysis was used to assess relationships among clinical, biochemical, and anthropometric profiles, areas of TAAT, SCAT, and IAAT, and 25(OH) D levels.

Results: The mean concentration of 25(OH) D was 40.5 ± 8.6 ng/mL. Overall, 6.6% had vitamin D deficiency (<10 ng/mL), 87.6% had insufficiency (<30 ng/mL), and 5.8% had a sufficient level (>30 ng/mL). Levels of 25(OH) D did not correlate with demographic, biochemical, and anthropometric profiles or with abdominal fat depots (TAAT, SCAT, and IAAT). In the correlation regression model, 25(OH) D was associated with TAAT in obese subjects.

Conclusions: In obese urban Asian Indians without diabetes, higher values of total abdominal fat at the L2-L3 intervertebral level were associated with low 25(OH) D levels.
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http://dx.doi.org/10.1089/dia.2013.0303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029135PMC
June 2014

Assessment of 11-β hydroxysteroid dehydrogenase (11-βHSD1) 4478T>G and tumor necrosis factor-α (TNF-α)-308G>A polymorphisms with obesity and insulin resistance in Asian Indians in North India.

Mol Biol Rep 2013 Nov;40(11):6261-70

11-β hydroxysteroid dehydrogenase (11-βHSD1), tumor necrosis factor-α (TNF-α) and their role in obesity, regional adiposity and insulin resistance has been sparsely evaluated. We determined the polymorphic status of 11-βHSD1 4478T>G and TNF-α-308G>A in Asian Indians in north India. In this cross-sectional study (n = 498; 258 males, 240 females), association of genotypes (PCR–RFLP) of 11-βHSD1 and TNF-α were analyzed with obesity [BMI ≥ 25 kg/m(2), percentage body fat (%BF by DEXA); subcutaneous and intra-abdominal fat area (L(2-3) level by single slice MRI) in a sub sample] and insulin resistance. 46 percent subjects had generalized obesity, 55 % abdominal obesity and 23.8 % were insulin resistant. Frequencies (%) of [T/T] and [T/G] genotypes of 11-βHSD1 were 89.57 and 10.43 respectively. Homozygosity for 11-βHSD1 4478G/G was absent with no association with parameters of obesity and insulin resistance. Frequencies (%) of TNF-α [G] and [A] alleles were 88 and 12 respectively. Higher frequency of variant -308[A/A] was observed in females versus males (p = 0.01). Females with at least one single A allele of TNF-α-308G>A had significantly high %BF and total skinfold, whereas higher values of waist hip ratio, total cholesterol, triglycerides and VLDL were observed in males. Subjects with even a single A allele in TNF-α genotype showed higher subscapular skinfold predisposing them to truncal subcutaneous adiposity (p = 0.02). Our findings of association of TNF-α-308G>A variant in females with obesity indices suggests a gender-specific role of this polymorphism in obesity. High truncal subcutaneous adiposity is associated with A allele of TNF-α-308G>A in this population.
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http://dx.doi.org/10.1007/s11033-013-2738-5DOI Listing
November 2013

Population-based intervention for cardiovascular diseases related knowledge and behaviours in Asian Indian women.

Indian Heart J 2013 Jan-Feb;65(1):40-7. Epub 2012 Dec 26.

Department of Biostatistics and Community Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background & Objectives: There is poor knowledge and behaviors regarding chronic diseases related nutritional and lifestyle factors among women in low income countries. To evaluate efficacy of a multilevel population-based intervention in improving knowledge and practices for related factors we performed a study in India.

Methods: Population based study among women 35-70 years was performed in four urban and five rural locations. Stratified sampling was performed and we enrolled 4624 (rural 2616, urban 2008) of eligible 8000 women (58%). Demographic details, medical history, diet, physical activity and anthropometry were recorded and blood hemoglobin, glucose and total cholesterol determined. Knowledge and behaviors regarding diet in chronic diseases were inquired in a randomly selected 100 women at each site (n = 900). A systematic multilevel population based intervention (using posters, handouts, street plays, public lectures, group lectures and focused group discussions) was administered over 6 months at each site. The questionnaire was re-administered at the end in random 100 women (n = 900) and differences determined. Descriptive statistics are reported. Comparison of parameters before and after intervention was assessed using Mann Whitney test.

Results: Prevalence (%) of chronic disease related lifestyles and risk factors in rural/urban women, respectively, was illiteracy in 63.6/29.4, smoking/tobacco use 39.3/18.9, high fat intake 93.6/93.4, high salt intake 18.2/12.6, low physical activity 59.5/70.2, overweight/obesity 22.5/45.6, truncal obesity 13.0/44.3, hypertension 31.6/48.2, hypercholesterolemia 13.5/27.7, and diabetes in 4.3/15.1 percent. Composite chronic diseases knowledge at baseline vs after intervention increased significantly in overall (32.0 vs 62.0), rural (29.0 vs 63.5) and urban (39.5 vs 60.5) groups (p < 0.001). Significant increase in knowledge regarding diet in hypertension, diabetes, heart disease and anemia as well as importance of dietary proteins, fats, fibres and fruits was observed (p < 0.001). There was insignificant change in most of the practices regarding intake of low fat, high protein, high fibre diet except sieving the flour which declined significantly (80.1 vs 53.6, p < 0.001).

Conclusions: A short-term multilevel population-wide intervention among women in rural and urban locations in India increased chronic disease knowledge but failed to influence practices.
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http://dx.doi.org/10.1016/j.ihj.2012.12.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860769PMC
December 2013

Radiation accident at Mayapuri scrap market, Delhi, 2010.

Radiat Prot Dosimetry 2012 Oct 21;151(4):645-51. Epub 2012 Aug 21.

Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.

This article reports the accidental public radiation exposure in a scrap market in Delhi, India, on March 2010. The source, a gamma unit containing Cobalt-60 pencils, was improperly disposed of by a research institution in violation of national regulations for radiation protection and safety of radioactive sources. The unit was sold off to unsuspecting scrap dealers who dismantled the equipment. This event subsequently caused the most severe radiation accident reported in India to date, resulting in seven radiation injuries and one death. The clinical course of five of the patients treated at the All India Institute of Medical Sciences hospital, New Delhi, is summarised in this report. All five patients suffered from the haematological form of the acute radiation syndrome and local cutaneous radiation injury as well. While four patients exposed to doses between 0.6 and 2.8 Gy survived with intensive or supportive treatment, the patient with the highest exposure of 3.1 Gy died due to acute respiratory distress syndrome and multi-organ failure on Day 16 after hospitalisation. The incident highlights the current gaps in the knowledge, infrastructure and legislation in handling radioactive materials. Medical institutions need to formulate individualised triage and management guidelines to immediately respond to future public radiological accidents.
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http://dx.doi.org/10.1093/rpd/ncs162DOI Listing
October 2012

Serum magnesium in overweight children.

Indian Pediatr 2012 Feb 30;49(2):109-12. Epub 2011 May 30.

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

Objective: To determine whether overweight children and adolescents have lower serum concentration and lower dietary intake of magnesium compared to those with normal weight; and to study the correlation of serum magnesium levels with components of metabolic syndrome in children and adolescents.

Design: Cross-sectional, comparative study.

Setting: General/Pediatric Endocrinolgy OPD tertiary care medical centre. Study done from July 2007 to March 2009

Participants: 55 overweight and 53 normal weight children and adolescents aged 4 years to 14 years.

Methods: We compared fasting levels of serum magnesium, insulin, glucose, total and HDL-cholesterol, triglycerides and dietary magnesium intake.

Results: The serum magnesium levels were significantly lower in overweight (2.12 ±; 0.33 mg/dL) compared to normal weight group (2.56 ± 0.24 mg/dL, P<0.001), while the dietary intake of magnesium (adjusted for calorie intake) was higher in overweight group (0.20 ± 0.06 mg/kcal) compared to normal weight (0.17 ± 0.05 mg/kcal; P= 0.005). Serum magnesium levels were inversely correlated with body mass index, systolic blood pressure, diastolic blood pressure, waist circumference and fasting insulin levels.

Conclusions: Serum magnesium levels were significantly lower in overweight children compared to those with normal weight in spite of a higher dietary intake.
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http://dx.doi.org/10.1007/s13312-012-0024-6DOI Listing
February 2012

Subcutaneous abdominal adipose tissue is associated with the metabolic syndrome in Asian Indians independent of intra-abdominal and total body fat.

Heart 2010 Apr;96(8):579-83

Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Hypothesis: Subcutaneous abdominal adipose tissue (SCAT) compared with intra-abdominal adipose tissue (IAAT) would be more significantly associated with the metabolic syndrome in Asian Indians.

Design: Cross-sectional study.

Setting: Tertiary care medical institution.

Subjects: 100 healthy adults without known heart disease or diabetes.

Interventions: Magnetic resonance imaging to measure cross-sectional areas of abdominal adipose tissue compartments at the L3-L4 intervertebral level. Dual energy x-ray absorptiometry to measure fat percentage (BF%) and lean mass of total body, trunk, legs and arms.

Results: Subjects with the metabolic syndrome (n=35) had a significantly higher BF%, SCAT and IAAT than those without it. Both SCAT and IAAT showed a significant correlation with blood pressure and triglycerides. One SD increase in IAAT (odds ratio (OR) 3.43; 95% CI 1.78 to 6.63) or SCAT area (OR 6.35; 95% CI 2.75 to 14.7) was significantly associated with the metabolic syndrome. On comparing them in the same model, SCAT was the only significant factor associated with the metabolic syndrome (OR 4.92; 95% CI, 1.95 to 12.38). In receiver operating characteristic curve analysis, significant areas under the curves (AUC) were noted for IAAT (0.77) and SCAT (0.89). On comparing the equality of AUC by C statistics, SCAT was a more significant predictor of the metabolic syndrome than IAAT (p=0.009). Only SCAT was significantly associated with the metabolic syndrome after adjusting for BF%, lean body mass or trunk lean mass.

Conclusion: SCAT is a more important predictor of the metabolic syndrome in Asian Indians than IAAT. The significance of SCAT in the pathogenesis of atherosclerosis and diabetes needs to be investigated further in Asian Indians.
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http://dx.doi.org/10.1136/hrt.2009.183236DOI Listing
April 2010

Role of selected Indian plants in management of type 2 diabetes: a review.

J Altern Complement Med 2004 Apr;10(2):369-78

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

Type 2 diabetes has become a global epidemic. Modern medicines, despite offering a variety of effective treatment options, can have several adverse effects. Ayurveda, a science that uses herbal medicines extensively, originated in India. Of considerable interest is the adoption of Ayurveda by the mainstream medical system in some European countries (e.g., Hungary), emphasizing this modality is increasing worldwide recognition. From ancient times, some of these herbal preparations have been used in the treatment of diabetes. This paper reviews the accumulated literature for 10 Indian herbs that have antidiabetic activity and that have been scientifically tested. Few of these herbs, such as Momordica charantia, Pterocarpus marsupium, and Trigonella foenum greacum, have been reported to be beneficial for treating type 2 diabetes. Mechanisms such as the stimulating or regenerating effect on beta cells or extrapancreatic effects are proposed for the hypoglycemic action of these herbs.
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http://dx.doi.org/10.1089/107555304323062365DOI Listing
April 2004

The role of lipids in the development of diabetic microvascular complications: implications for therapy.

Am J Cardiovasc Drugs 2003 ;3(5):325-38

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

Dyslipidemia is a major factor responsible for coronary heart disease and its reduction decreases coronary risk in patients with diabetes mellitus. However, the association of dyslipidemia with microvascular complications and the effect of intervention with lipid-lowering therapy in diabetes have been less investigated. We present the systematic review of association and intervention studies pertaining to dyslipidemia and microvascular disease in diabetes and also review possible mechanisms. Dyslipidemia may cause or exacerbate diabetic retinopathy and nephropathy by alterations in the coagulation-fibrinolytic system, changes in membrane permeability, damage to endothelial cells and increased atherosclerosis. Hyperlipidemia is associated with faster decline in glomerular filtration rate and progression of albuminuria and nephropathy. Recent evidence also suggests a role of lipoprotein(a) in progression of retinopathy and nephropathy in patients with diabetes mellitus. Lipid-lowering therapy, using single agents or a combination of drugs may significantly benefit diabetic retinopathy and diabetic nephropathy. In particular, hydroxymethyl glutaryl coenzyme A reductase inhibitors may be effective in preventing or retarding the progression of microvascular complications because of their powerful lipid-lowering effects and other additional mechanisms. However, most of the data are based on short-term studies, and need to be ascertained in long-term studies. Until more specific guidelines are available, aggressive management of diabetic dyslipidemia, according to currently accepted guidelines, should be continued for the prevention of macrovascular disease which would also benefit microvascular complications.
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http://dx.doi.org/10.2165/00129784-200303050-00004DOI Listing
October 2004

Soluble inter-cellular adhesion molecule-1 in urban Asian north Indians: relationships with anthropometric and metabolic covariates.

Dis Markers 2002 ;18(3):111-20

Department of Medicine, All India Institute of Medical Sciences, New Delhi.

Background: High prevalence of diabetes, obesity, and dyslipidemias in people belonging to poor socio-economic strata in urban slums of northern India has been recorded recently. To assess whether this population has high levels of soluble intercellular adhesion molecule-1 (sICAM-1), a cytokine involved in the pathogenesis of atherosclerosis, we investigated subjects belonging to poor socio-economic strata in urban slums and compared them to healthy control subjects from non-slum urban areas of New Delhi.

Design: Cross-sectional study.

Methods: Subjects from a previously carried out cross-sectional study, Delhi Urban Slum Project (DUSP) were divided into two groups: Group-1 (n = 56) included subjects dwelling in slum area, having at least one risk factor (hypertension, hyperglycemia, hypertriglyceridemia and hypercholesterolemia), while group-2 (n = 60) consisted of subjects without any risk factor dwelling in the slum area. A third group (n = 29) of non-obese subjects without any risk factor living in non-slum urban area was included for comparison. Measurements included; body mass index (BMI), waist-hip ratio (W-HR), four skinfolds, percentage body fat, fasting plasma glucose (FPG), serum lipids, and serum levels of sICAM-1.

Results: Though statistically not significant, mean level of sICAM-1 was higher in group-1 (718.5 +/- 232.8 ng/ml) as compared to the other groups. Of note, 35% of subjects in group-1 (p < 0.05 as compared to other two groups), and 25.3% of all subjects had levels of sICAM-1 in uppermost quartile (> 850 ng/ml). Partial correlation coefficients (R) of sICAM-1 levels with various parameters adjusted for age were statistically significant for BMI (R = 0.27, p < 0.05) in group-1; W-HR (R = 0.26, p < 0.05) and BMI (R = 0.19, p < 0.05) for group-2; and FPG (R = 0.17, p < 0.05) for all the subjects considered together. For females, the levels of sICAM-1 were significantly higher in the following: BMI > OR = 25 kg/m2 (p = 0.04) and FPG > 7 mmol/l (p < 0.05). Multiple linear regression analysis suggests that an increment in BMI by one kg/m2 would correspond to an increase in the levels of sICAM-1 by 8.5 units controlling for the influence of age and W-HR in the pooled data of all subjects.

Conclusions: High percentage of subjects had levels of sICAM-1 in the upper quartile in the study, particularly those dwelling in the slum area and having coronary risk factor (s). The levels of sICAM-1 strongly correlated to the anthropometric and metabolic parameters, particularly in females. These observations are of potential importance for the pathogenesis of atherosclerosis in this population, though further studies are needed to predict those prone to the complications of atherosclerosis, based on sICAM-1 levels, as has been observed in other ethnic groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851618PMC
http://dx.doi.org/10.1155/2002/843537DOI Listing
May 2003